Healthcare Provider Details

I. General information

NPI: 1578536314
Provider Name (Legal Business Name): LINDA CIU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2006
Last Update Date: 11/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 MAIN ST
MEDWAY MA
02053-1800
US

IV. Provider business mailing address

116 MAIN ST
MEDWAY MA
02053-1800
US

V. Phone/Fax

Practice location:
  • Phone: 508-533-6020
  • Fax: 508-533-6640
Mailing address:
  • Phone: 508-533-6020
  • Fax: 508-533-6640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number219184
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number219184
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: