Provider Demographics
NPI:1689647257
Name:LUONG, LINDA L (MD)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:L
Last Name:LUONG
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 1:771 ALBANY ST
Mailing Address - Street 2:DOWLING 5 SOUTH
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2525
Mailing Address - Country:US
Mailing Address - Phone:617-414-4465
Mailing Address - Fax:617-414-3345
Practice Address - Street 1:44 W JUBAL EARLY DRIVE
Practice Address - Street 2:SUITE 240
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601
Practice Address - Country:US
Practice Address - Phone:540-450-2702
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA213085207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA011349W95Medicare PIN
MAH65653Medicare UPIN