Provider Demographics
NPI:1376677906
Name:CARLOW, LINDA HELEN
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:HELEN
Last Name:CARLOW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1580 PONTIAC AVE
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02920-4406
Mailing Address - Country:US
Mailing Address - Phone:401-738-6450
Mailing Address - Fax:401-732-5369
Practice Address - Street 1:1580 PONTIAC AVE
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02920-4406
Practice Address - Country:US
Practice Address - Phone:401-738-6450
Practice Address - Fax:401-732-5369
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2009-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RICO00006222Z00000X, 225000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR9703OtherBC BS OF RI
RI9009703Medicaid
RI9009703Medicaid