Healthcare Provider Details

I. General information

NPI: 1134174592
Provider Name (Legal Business Name): LINDA K SNELLING MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 03/13/2024
Certification Date: 03/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

593 EDDY ST
PROVIDENCE RI
02903-4923
US

IV. Provider business mailing address

593 EDDY ST HASBRO 122
PROVIDENCE RI
02903-4923
US

V. Phone/Fax

Practice location:
  • Phone: 401-421-4201
  • Fax: 401-444-5527
Mailing address:
  • Phone: 401-444-6484
  • Fax: 401-444-6378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License NumberMD08228
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License NumberMD08228
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: