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General NPI Number Information
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NPI Number | 1427250695
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Entity Type | Organization
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Legal Business Name | LINDA H. LEAVENWORTH, M.D., P.C.
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Dates
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Enumeration Date | 06/01/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 411 MASSACHUSETTS AVE SUITE 202
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City | ACTON
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State | MA
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Zip | 01720-3739
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Country | US
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Telephone | 978-635-0477
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Fax |
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Provider Business Mailing Address
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Address Line | 411 MASSACHUSETTS AVENUE SUITE 202
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City | ACTON
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State | MA
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Zip | 01720
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Country | US
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Telephone | 978-635-0477
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Fax |
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Authorized Official
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Title or Position | DIRECT OWNER
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Name | DR. LINDA H LEAVENWORTH
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Credential | M.D.
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Telephone | 978-635-0477
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | 56101
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License Number State | MA
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