Provider Demographics
NPI:1285666735
Name:GOSSELIN CHASE, LINDA (MD)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:
Last Name:GOSSELIN CHASE
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 1:2340 HIGHWAY 180 E # 307
Mailing Address - Street 2:
Mailing Address - City:SILVER CITY
Mailing Address - State:NM
Mailing Address - Zip Code:88061-7782
Mailing Address - Country:US
Mailing Address - Phone:575-313-9804
Mailing Address - Fax:
Practice Address - Street 1:2340 HIGHWAY 180 E # 307
Practice Address - Street 2:
Practice Address - City:SILVER CITY
Practice Address - State:NM
Practice Address - Zip Code:88061-7782
Practice Address - Country:US
Practice Address - Phone:575-313-9804
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM9862207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NME28600Medicare UPIN