Provider Demographics
NPI:1699885772
Name:DODGE, LINDA L (NP)
Entity type:Individual
Prefix:MS
First Name:LINDA
Middle Name:L
Last Name:DODGE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:85 PRESCOTT ST
Mailing Address - Street 2:SUITE 304
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-2610
Mailing Address - Country:US
Mailing Address - Phone:508-753-7259
Mailing Address - Fax:508-753-9577
Practice Address - Street 1:85 PRESCOTT ST
Practice Address - Street 2:SUITE 304
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-2610
Practice Address - Country:US
Practice Address - Phone:508-753-7259
Practice Address - Fax:508-753-9577
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2013-05-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA86175363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0354503Medicaid
MA0354503Medicaid
NPP000Medicare UPIN