Healthcare Provider Details

I. General information

NPI: 1194793109
Provider Name (Legal Business Name): LINDA A PERLINE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 01/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11085 LITTLE PATUXENT PKWY SUITE 101
COLUMBIA MD
21044-2983
US

IV. Provider business mailing address

11085 LITTLE PATUXENT PKWY SUITE 101
COLUMBIA MD
21044-2983
US

V. Phone/Fax

Practice location:
  • Phone: 410-997-7979
  • Fax: 410-964-1588
Mailing address:
  • Phone: 410-997-7979
  • Fax: 410-997-9231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC00999
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: