Provider Demographics
NPI:1407851835
Name:BARRASSE, LINDA D (MD)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:D
Last Name:BARRASSE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:CLARKS SUMMIT
Mailing Address - State:PA
Mailing Address - Zip Code:18411-1061
Mailing Address - Country:US
Mailing Address - Phone:570-587-7819
Mailing Address - Fax:570-587-7815
Practice Address - Street 1:746 JEFFERSON AVE
Practice Address - Street 2:STE 305
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18510-1639
Practice Address - Country:US
Practice Address - Phone:570-342-1776
Practice Address - Fax:570-963-0663
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD027051E207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAB37028Medicare UPIN
PA117210Medicare ID - Type UnspecifiedMEDICARE PROVIDER #