Provider Demographics
NPI:1215968144
Name:GIFFORD, LINDA S (DO)
Entity type:Individual
Prefix:DR
First Name:LINDA
Middle Name:S
Last Name:GIFFORD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 GLEN COVE DR
Mailing Address - Street 2:
Mailing Address - City:ROCKPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04856-4272
Mailing Address - Country:US
Mailing Address - Phone:207-301-8542
Mailing Address - Fax:207-301-5277
Practice Address - Street 1:6 GLEN COVE DR
Practice Address - Street 2:
Practice Address - City:ROCKPORT
Practice Address - State:ME
Practice Address - Zip Code:04856-4272
Practice Address - Country:US
Practice Address - Phone:207-302-8542
Practice Address - Fax:207-302-5277
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAETL4952207Q00000X
MIEMC0001000207Q00000X
ME1833207Q00000X
MDH94733207Q00000X
MEME1833208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME431966399Medicaid
MEI42375Medicare UPIN
MESX3793Medicare PIN
ME431966399Medicaid
MEP00811450Medicare PIN