Provider Demographics
NPI:1023098209
Name:BORNSTEIN, LINDA ESTHER (MD)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:ESTHER
Last Name:BORNSTEIN
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 1:3350 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01107-1112
Mailing Address - Country:US
Mailing Address - Phone:413-794-9175
Mailing Address - Fax:413-794-5153
Practice Address - Street 1:3350 MAIN ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107-1112
Practice Address - Country:US
Practice Address - Phone:413-794-9175
Practice Address - Fax:413-794-5153
Is Sole Proprietor?:No
Enumeration Date:2006-01-22
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA773722085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3051765Medicaid
MAJ08872Medicare ID - Type Unspecified
MA3051765Medicaid