Healthcare Provider Details

I. General information

NPI: 1972592640
Provider Name (Legal Business Name): LINDA M CHAFFKIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 SEYMOUR ST SUITE 507
HARTFORD CT
06106-5501
US

IV. Provider business mailing address

30 PENNY LN
WOODBRIDGE CT
06525-1531
US

V. Phone/Fax

Practice location:
  • Phone: 860-548-1383
  • Fax:
Mailing address:
  • Phone: 203-494-4039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number030375
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: