Provider Demographics
NPI:1396739116
Name:BASSETT SHAFTOE, LINDA ANNE (MD)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:ANNE
Last Name:BASSETT SHAFTOE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 7200
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-0200
Mailing Address - Country:US
Mailing Address - Phone:252-937-0200
Mailing Address - Fax:252-451-0056
Practice Address - Street 1:901 N WINSTEAD AVE
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-8467
Practice Address - Country:US
Practice Address - Phone:252-937-0235
Practice Address - Fax:252-937-3103
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9500717207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC110124023OtherRAILROAD MEDICARE
NC9592084OtherCIGNA HEALTHCARE
NC9592084OtherCIGNA
NC7540NOtherBCBS OF NC
NC68581OtherMEDCOST
NC7540NOtherBCBSNC
NC897540NMedicaid
NC1445603OtherUNITED HEALTH CARE