Provider Demographics
NPI:1720175144
Name:MITCHELL-FRYE, LINDA K (MD)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:K
Last Name:MITCHELL-FRYE
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 1:105 MCALPINE LN
Mailing Address - Street 2:
Mailing Address - City:LAURINBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28352-4637
Mailing Address - Country:US
Mailing Address - Phone:910-277-3331
Mailing Address - Fax:910-277-3336
Practice Address - Street 1:105 MCALPINE LN
Practice Address - Street 2:
Practice Address - City:LAURINBURG
Practice Address - State:NC
Practice Address - Zip Code:28352-4637
Practice Address - Country:US
Practice Address - Phone:910-277-3331
Practice Address - Fax:910-277-3336
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC39911207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC59565OtherBCBS ID NUMBER
SCN39911Medicaid
NC8959565Medicaid
NC160048341OtherRAILROAD MEDICARE ID NUMB
NC8959565Medicaid
NC2190248FMedicare ID - Type UnspecifiedMEDICARE ID NUMBER