Basic Information
| Provider Information | |||||||||
| NPI: | 1104811546 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WERNER | ||||||||
| FirstName: | LINDA | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 115 TECHNOLOGY DR UNIT C101 | ||||||||
| Address2: | |||||||||
| City: | TRUMBULL | ||||||||
| State: | CT | ||||||||
| PostalCode: | 066116300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2033727200 | ||||||||
| FaxNumber: | 2033741473 | ||||||||
| Practice Location | |||||||||
| Address1: | 115 TECHNOLOGY DR UNIT C101 | ||||||||
| Address2: | |||||||||
| City: | TRUMBULL | ||||||||
| State: | CT | ||||||||
| PostalCode: | 066116300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2033727200 | ||||||||
| FaxNumber: | 2033741473 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/12/2005 | ||||||||
| LastUpdateDate: | 02/19/2018 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RE0101X | 035232 | CT | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism |
ID Information
| ID | Type | State | Issuer | Description | 0865017 | 01 | CT | CIGNA PROVIDER ID | OTHER | 3714960 | 01 | CT | AETNA PROVIDER ID | OTHER | 010035232CT02 | 01 | CT | ANTHEM PROVIDER ID | OTHER | P00211254 | 01 | CT | MEDICARE RAILROAD # | OTHER | 2V5413 | 01 | CT | HNET PROVIDER ID | OTHER | 721835 | 01 | CT | CONNECTICARE PROVIDER ID | OTHER | 001352327 | 05 | CT | MEDICAID | 010035232CT02 | 01 | CT | ANTHEM BC FAMILY | OTHER | P404869 | 01 | CT | OXFORD PROVIDER ID | OTHER |