Provider Demographics
NPI:1982604039
Name:EVERETT, LINDA GILLESPIE (MD)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:GILLESPIE
Last Name:EVERETT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:RAMONA
Other - Last Name:GILLESPIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1284 GAP NEWPORT PIKE
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19311-9503
Mailing Address - Country:US
Mailing Address - Phone:610-268-5560
Mailing Address - Fax:888-557-4504
Practice Address - Street 1:2217 BALTIMORE PIKE
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:PA
Practice Address - Zip Code:19363-4013
Practice Address - Country:US
Practice Address - Phone:610-932-3281
Practice Address - Fax:610-932-8612
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD425340207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H71740Medicare UPIN