Healthcare Provider Details

I. General information

NPI: 1003806480
Provider Name (Legal Business Name): ELIZABETH LINDER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH WATTS

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 06/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 GRAFTON RD.
TOWNSHEND VT
05353
US

IV. Provider business mailing address

PO BOX 216
TOWNSHEND VT
05353-0216
US

V. Phone/Fax

Practice location:
  • Phone: 802-365-4331
  • Fax:
Mailing address:
  • Phone: 802-365-4331
  • Fax: 802-365-7031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0420009583
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: