Healthcare Provider Details

I. General information

NPI: 1942351853
Provider Name (Legal Business Name): LINDA M SHUCK DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LINDA M PLEVICH DO

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 05/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 WHITE ST UNIT 1
DOBSON NC
27017-8938
US

IV. Provider business mailing address

PO BOX 920 306 WHITE STREET
DOBSON NC
27017-0920
US

V. Phone/Fax

Practice location:
  • Phone: 336-386-4477
  • Fax: 336-386-8005
Mailing address:
  • Phone: 336-386-4477
  • Fax: 336-386-8005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number2005-00550
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier140AV
Identifier TypeOTHER
Identifier StateNC
Identifier IssuerBCBS
# 2
Identifier5901096
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer
# 3
Identifier37753
Identifier TypeOTHER
Identifier StateNC
Identifier IssuerPARTNERS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: