Healthcare Provider Details

I. General information

NPI: 1255416475
Provider Name (Legal Business Name): LINDA LOUISE REXFORD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. LINDA REXFORD KHAMSYVORAVONG

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 10/19/2020
Certification Date: 10/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 COMMERCE ST SUITE 100
LINCOLN RI
02865-1186
US

IV. Provider business mailing address

1 COMMERCE ST SUITE 100
LINCOLN RI
02865-1186
US

V. Phone/Fax

Practice location:
  • Phone: 401-793-8484
  • Fax: 401-793-8481
Mailing address:
  • Phone: 401-793-8484
  • Fax: 401-793-8481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number5583
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: