Provider Demographics
NPI:1255416475
Name:REXFORD, LINDA LOUISE (MD)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:LOUISE
Last Name:REXFORD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:LINDA
Other - Middle Name:REXFORD
Other - Last Name:KHAMSYVORAVONG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1 COMMERCE ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LINCOLN
Mailing Address - State:RI
Mailing Address - Zip Code:02865-1186
Mailing Address - Country:US
Mailing Address - Phone:401-793-8484
Mailing Address - Fax:401-793-8481
Practice Address - Street 1:1 COMMERCE ST
Practice Address - Street 2:SUITE 100
Practice Address - City:LINCOLN
Practice Address - State:RI
Practice Address - Zip Code:02865-1186
Practice Address - Country:US
Practice Address - Phone:401-793-8484
Practice Address - Fax:401-793-8481
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI5583208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI2096166OtherBLUE CROSS
RI1201622OtherUNITED HEALTH
RIPP31923Medicaid
D87219Medicare UPIN