Provider Demographics
NPI:1356478127
Name:MERCHANT, LINDA R (MED CCC-A)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:R
Last Name:MERCHANT
Suffix:
Gender:F
Credentials:MED CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 MILLDAM RD
Mailing Address - Street 2:
Mailing Address - City:ACTON
Mailing Address - State:MA
Mailing Address - Zip Code:01720-5847
Mailing Address - Country:US
Mailing Address - Phone:978-263-2762
Mailing Address - Fax:
Practice Address - Street 1:525 MAIN ST
Practice Address - Street 2:
Practice Address - City:ACTON
Practice Address - State:MA
Practice Address - Zip Code:01720-3934
Practice Address - Country:US
Practice Address - Phone:978-264-4300
Practice Address - Fax:978-264-4330
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA406231H00000X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Not Answered237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
MASP 406-AUOtherAUDIOLOGY LICENSE NUMBER
MA70010000AD0090OtherBLUE CROSS PROVIDER ID
MASP 406-AUOtherAUDIOLOGY LICENSE NUMBER