Healthcare Provider Details

I. General information

NPI: 1023125671
Provider Name (Legal Business Name): LINDA F SANBORN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 01/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94 MAIN ST
GORHAM ME
04038-1340
US

IV. Provider business mailing address

39 WALLACE AVE
SOUTH PORTLAND ME
04106-6143
US

V. Phone/Fax

Practice location:
  • Phone: 207-839-5225
  • Fax: 207-839-7850
Mailing address:
  • Phone: 207-761-0650
  • Fax: 207-761-8198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number010920
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: