Healthcare Provider Details

I. General information

NPI: 1760407712
Provider Name (Legal Business Name): LINDA J. WEINER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4489 PAPALINA RD
KALAHEO HI
96741-8503
US

IV. Provider business mailing address

PO BOX 520
KALAHEO HI
96741-0520
US

V. Phone/Fax

Practice location:
  • Phone: 808-332-8523
  • Fax: 808-332-7050
Mailing address:
  • Phone: 808-332-8523
  • Fax: 808-332-7050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD-2938
License Number StateHI

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierMD2938-01
Identifier TypeOTHER
Identifier State
Identifier IssuerLONGS/MDX
# 2
Identifier03681601
Identifier TypeOTHER
Identifier State
Identifier IssuerALOHACARE
# 3
Identifier03681601
Identifier TypeMEDICAID
Identifier StateHI
Identifier Issuer
# 4
Identifier7768488
Identifier TypeOTHER
Identifier State
Identifier IssuerUHA
# 5
IdentifierC97858
Identifier TypeOTHER
Identifier State
Identifier IssuerKAISER
# 6
Identifier99-0262194
Identifier TypeOTHER
Identifier State
Identifier IssuerHMAA
# 7
Identifier00A0040525
Identifier TypeOTHER
Identifier State
Identifier IssuerHMSA
# 8
Identifier99-0262194
Identifier TypeOTHER
Identifier State
Identifier IssuerHMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: