Provider Demographics
NPI:1699890681
Name:COFFIN, LINDA CAROL (MD)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:CAROL
Last Name:COFFIN
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 1:169 GEORGE ST
Mailing Address - Street 2:
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-3853
Mailing Address - Country:US
Mailing Address - Phone:401-724-3287
Mailing Address - Fax:401-312-2321
Practice Address - Street 1:169 GEORGE ST
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-3853
Practice Address - Country:US
Practice Address - Phone:401-724-3287
Practice Address - Fax:401-312-2321
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRI06386207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIA79765Medicare UPIN