Provider Demographics
NPI:1982613048
Name:VANDERLINDE, JAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JAN
Middle Name:
Last Name:VANDERLINDE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 BREEZY WAY
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:NH
Mailing Address - Zip Code:03825-3751
Mailing Address - Country:US
Mailing Address - Phone:072-752-0862
Mailing Address - Fax:
Practice Address - Street 1:1 AYER CIR BLDG H1
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03804
Practice Address - Country:US
Practice Address - Phone:207-458-5981
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH9956207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
930100687OtherRAILROAD MEDICARE
NH0100859Y0NH01OtherANTHEM
AA14477OtherHARVARD PILGRIM
NH30201163Medicaid
MA0113051Medicaid
ME332970099Medicaid
MA0113051Medicaid
NH0100859Y0NH01OtherANTHEM
NHRE4493Medicare ID - Type Unspecified