MEDICARE: LINDA CORNTHWAITE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	06962	MD

General Provider Information

NPI Number	:	1255801155
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDA CORNTHWAITE

Provider Business Mailing Address
First Line	:	2 RAYLON DR APT L
Second Line	:
City	:	NOTTINGHAM
State	:	MD
Zip	:	21236-4942
Country	:	US
Telephone Number	:	443-722-9163
Fax Number	:

Provider Business Practice Location Address
First Line	:	2706 PHILADELPHIA RD
Second Line	:
City	:	ABINGDON
State	:	MD
Zip	:	21009-2322
Country	:	US
Telephone Number	:	410-612-2033
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/04/2018
Last Update Date	:	12/04/2018

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Directions to “ LINDA CORNTHWAITE ” Practice Location

Language	Start Address	Practice Location

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