Provider Demographics
NPI:1326014366
Name:WELLES, LINDA B (MD)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:B
Last Name:WELLES
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:601 ELMWOOD AVE
Mailing Address - Street 2:BOX 670
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0001
Mailing Address - Country:US
Mailing Address - Phone:607-301-4141
Mailing Address - Fax:607-301-4140
Practice Address - Street 1:84 CANAL ST
Practice Address - Street 2:
Practice Address - City:BIG FLATS
Practice Address - State:NY
Practice Address - Zip Code:14814-8968
Practice Address - Country:US
Practice Address - Phone:607-301-4141
Practice Address - Fax:607-301-4140
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2012-02-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY244687207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02285867Medicaid
E52805Medicare UPIN