Provider Demographics
NPI:1457458614
Name:LINSCOTT, MARA (MD)
Entity Type:Individual
Prefix:
First Name:MARA
Middle Name:
Last Name:LINSCOTT
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 1:5 TARKILN RD
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02364-1250
Mailing Address - Country:US
Mailing Address - Phone:781-585-2200
Mailing Address - Fax:781-585-1784
Practice Address - Street 1:5 TARKILN ROAD
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:MA
Practice Address - Zip Code:02364-1250
Practice Address - Country:US
Practice Address - Phone:781-585-2200
Practice Address - Fax:781-585-1784
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA242263207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110084539AMedicaid
042297845OtherHCVM/FIRST HEALTH/COVENTRY
495210OtherTUFTS MEDICARE PREFERRED
042297845OtherGIC/UNICARE
042297845OtherPHCS/MULTI-PLAN
042297845OtherTRICARE
1457458614OtherFALLON
MAJ46719OtherBCBSMA
7984860OtherAETNA
042297845OtherUNITED HEALTH CARE
495210OtherTUFTS
1457458614OtherNHP
6395310OtherCIGNA
AA169440OtherHARVARD PILGRIM
7984860OtherAETNA
MAJ46719OtherBCBSMA