MEDICARE: LINDA VAN DER MEULEN RPA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	004194	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558394742
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDA VAN DER MEULEN RPA-C

Provider Business Mailing Address
First Line	:	2 SHERMAN POTTS DRIVE
Second Line	:	SUITE 203
City	:	GHENT
State	:	NY
Zip	:	12075-3216
Country	:	US
Telephone Number	:	518-392-2277
Fax Number	:	518-392-7883

Provider Business Practice Location Address
First Line	:	2 SHERMAN POTTS DRIVE
Second Line	:	SUITE 203
City	:	GHENT
State	:	NY
Zip	:	12075-3216
Country	:	US
Telephone Number	:	518-392-2277
Fax Number	:	518-392-7883

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/09/2006
Last Update Date	:	07/21/2022

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Directions to “ LINDA VAN DER MEULEN RPA-C” Practice Location

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