Provider Demographics
NPI:1851366751
Name:GOTTFRIED, LINDA P (MD)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:P
Last Name:GOTTFRIED
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 1:4374 NEW TOWN AVE
Mailing Address - Street 2:STE 202
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-2865
Mailing Address - Country:US
Mailing Address - Phone:757-259-5116
Mailing Address - Fax:757-510-9063
Practice Address - Street 1:4374 NEW TOWN AVE
Practice Address - Street 2:STE 202
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-2865
Practice Address - Country:US
Practice Address - Phone:757-259-5116
Practice Address - Fax:757-510-9063
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101053057208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010099978Medicaid
VA010099978Medicaid
G45514Medicare UPIN