Provider Demographics
NPI:1578183711
Name:LINNEMAN, TYCIE (MD)
Entity Type:Individual
Prefix:
First Name:TYCIE
Middle Name:
Last Name:LINNEMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 WELLS VIEW RD
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:CT
Mailing Address - Zip Code:06484-5661
Mailing Address - Country:US
Mailing Address - Phone:660-973-6667
Mailing Address - Fax:
Practice Address - Street 1:142 WELLS VIEW RD
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-5661
Practice Address - Country:US
Practice Address - Phone:660-973-6667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-17
Last Update Date:2020-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
39390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program