Provider Demographics
NPI:1093716839
Name:WILLIS, LINDA L (MD)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:L
Last Name:WILLIS
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 1:131 ROUNDABOUT CT
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-3573
Mailing Address - Country:US
Mailing Address - Phone:252-443-4024
Mailing Address - Fax:252-443-5021
Practice Address - Street 1:131 ROUNDABOUT CT
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-3573
Practice Address - Country:US
Practice Address - Phone:252-443-4024
Practice Address - Fax:252-443-5021
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC360752085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89-88111Medicaid
NC89-88111Medicaid
NC2223944DMedicare PIN