Provider Demographics
NPI:1699753970
Name:ROBINSON, LINDA MOORE (MD)
Entity type:Individual
Prefix:DR
First Name:LINDA
Middle Name:MOORE
Last Name:ROBINSON
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:PO BOX 819
Mailing Address - Street 2:
Mailing Address - City:COATS
Mailing Address - State:NC
Mailing Address - Zip Code:27521-0819
Mailing Address - Country:US
Mailing Address - Phone:910-897-6423
Mailing Address - Fax:910-897-2540
Practice Address - Street 1:25 NORTH JOHNSON STREET
Practice Address - Street 2:
Practice Address - City:COATS
Practice Address - State:NC
Practice Address - Zip Code:27521-0819
Practice Address - Country:US
Practice Address - Phone:910-897-6423
Practice Address - Fax:910-897-2540
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200001240471174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89014N5Medicaid
NC0123LOtherBCBS ID NUMBER
NC412060502OtherTAX ID NUMBER
NC412060502OtherTAX ID NUMBER
NC212676AMedicare ID - Type UnspecifiedMCARE NUMBER