Healthcare Provider Details

I. General information

NPI: 1184976276
Provider Name (Legal Business Name): LINDA D BLOCK M.A. CCC/A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2012
Last Update Date: 10/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MEDICAL CENTER BLVD
WINSTON SALEM NC
27157-0001
US

IV. Provider business mailing address

WAKE FOREST BAPTIST MEDICAL CENTER MEDICAL CENTER BLVD
WINSTON-SALEM NC
27012-1166
US

V. Phone/Fax

Practice location:
  • Phone: 336-716-6480
  • Fax: 336-716-7300
Mailing address:
  • Phone: 336-716-6480
  • Fax: 336-716-7300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number1345
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: