MEDICARE: LINDA AUGUSTA HEFFERNAN M.D./P.H.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	2016-00343	NC
2	207N00000X	Dermatology Physician	0101259854	VA

General Provider Information

NPI Number	:	1275895666
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDA AUGUSTA HEFFERNAN M.D./P.H.D.

Provider Business Mailing Address
First Line	:	801 YORK ST
Second Line	:
City	:	MANITOWOC
State	:	WI
Zip	:	54220-4630
Country	:	US
Telephone Number	:	920-663-9008
Fax Number	:	920-684-1439

Provider Business Practice Location Address
First Line	:	7560 CARPENTER FIRE STATION RD STE 204
Second Line	:
City	:	CARY
State	:	NC
Zip	:	27519-9637
Country	:	US
Telephone Number	:	919-439-4206
Fax Number	:	919-439-9375

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/12/2012
Last Update Date	:	10/09/2025

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