Provider Demographics
NPI:1457040099
Name:DEFRUSCIO, LINDA
Entity type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:
Last Name:DEFRUSCIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 DEXTER AVE
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-4226
Mailing Address - Country:US
Mailing Address - Phone:617-964-1000
Mailing Address - Fax:
Practice Address - Street 1:831 MAIN ST STE 4
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:MA
Practice Address - Zip Code:01890-1997
Practice Address - Country:US
Practice Address - Phone:617-964-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA633174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist