Provider Demographics
NPI:1982613048
Name:VANDERLINDE, JAN (MD)
Entity type:Individual
Prefix:
First Name:JAN
Middle Name:
Last Name:VANDERLINDE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 BREEZY WAY
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:NH
Mailing Address - Zip Code:03825-3751
Mailing Address - Country:US
Mailing Address - Phone:072-752-0862
Mailing Address - Fax:
Practice Address - Street 1:402 GOODRICH AVENUE
Practice Address - Street 2:
Practice Address - City:KITTERY
Practice Address - State:ME
Practice Address - Zip Code:03904
Practice Address - Country:US
Practice Address - Phone:207-438-5981
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2024-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH99562083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0113051Medicaid
930100687OtherRAILROAD MEDICARE
NH30201163Medicaid
ME332970099Medicaid
NH0100859Y0NH01OtherANTHEM
AA14477OtherHARVARD PILGRIM
MA0113051Medicaid
NH0100859Y0NH01OtherANTHEM
NHRE4493Medicare ID - Type Unspecified