Provider Demographics
NPI:1992790067
Name:BISSON, LINDA (MD)
Entity type:Individual
Prefix:MS
First Name:LINDA
Middle Name:
Last Name:BISSON
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 1:165 SHERMAN DRIVE
Mailing Address - Street 2:
Mailing Address - City:ST. JOHNSBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05819
Mailing Address - Country:US
Mailing Address - Phone:802-748-9405
Mailing Address - Fax:802-748-4540
Practice Address - Street 1:26 CEDAR LANE
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VT
Practice Address - Zip Code:05828-9751
Practice Address - Country:US
Practice Address - Phone:802-454-8336
Practice Address - Fax:802-454-8339
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301069175207Q00000X
VT042-0011825207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3310277Medicaid
MI080109066OtherRAILROAD MEDICARE
MI3310277Medicaid
MIOM309200008Medicare PIN