Provider Demographics
NPI:1760539449
Name:DEFRAHN, LINDA SUZETTE (DO)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:SUZETTE
Last Name:DEFRAHN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3855 DARTMOUTH COLLEGE HWY
Mailing Address - Street 2:
Mailing Address - City:NORTH HAVERHILL
Mailing Address - State:NH
Mailing Address - Zip Code:03774-4909
Mailing Address - Country:US
Mailing Address - Phone:603-787-6971
Mailing Address - Fax:603-787-2035
Practice Address - Street 1:3855 DARTMOUTH COLLEGE HWY
Practice Address - Street 2:
Practice Address - City:NORTH HAVERHILL
Practice Address - State:NH
Practice Address - Zip Code:03774-4909
Practice Address - Country:US
Practice Address - Phone:603-787-6971
Practice Address - Fax:603-787-2035
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH8857207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHE75374Medicare UPIN