Healthcare Provider Details

I. General information

NPI: 1609864768
Provider Name (Legal Business Name): LINN LARSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 10/14/2020
Certification Date: 10/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 EXCHANGE ST
MIDDLEBURY VT
05753-4464
US

IV. Provider business mailing address

1330 EXCHANGE ST
MIDDLEBURY VT
05753-4464
US

V. Phone/Fax

Practice location:
  • Phone: 802-388-1500
  • Fax: 802-388-0441
Mailing address:
  • Phone: 802-388-1500
  • Fax: 802-388-0441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0420008411
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: