Provider Demographics
NPI:1053562942
Name:DEGAETA, LINDA R (MD)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:R
Last Name:DEGAETA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:20 SHEEPHILL DR
Mailing Address - Street 2:
Mailing Address - City:GLADSTONE
Mailing Address - State:NJ
Mailing Address - Zip Code:07934-2129
Mailing Address - Country:US
Mailing Address - Phone:908-234-0125
Mailing Address - Fax:732-469-9180
Practice Address - Street 1:20 SHEEPHILL DR
Practice Address - Street 2:
Practice Address - City:GLADSTONE
Practice Address - State:NJ
Practice Address - Zip Code:07934-2129
Practice Address - Country:US
Practice Address - Phone:908-234-0125
Practice Address - Fax:732-469-9180
Is Sole Proprietor?:No
Enumeration Date:2008-10-09
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA042722002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology