Provider Demographics
NPI:1144580614
Name:LINTHAVONG, OLIVIA (MD)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:
Last Name:LINTHAVONG
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:WOMEN'S HOSPITAL - Z035
Mailing Address - Street 2:801 GREEN VALLEY ROAD
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-0001
Mailing Address - Country:US
Mailing Address - Phone:336-832-6518
Mailing Address - Fax:
Practice Address - Street 1:801 GREEN VALLEY RD
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-7021
Practice Address - Country:US
Practice Address - Phone:336-832-6518
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-18
Last Update Date:2018-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2015016072080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal MedicineGroup - Single Specialty