MEDICARE: DR. ALLISON MARIE LINQUIST M.D.

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	207N00000X	Dermatology Physician	D0060242	MD

General Provider Information

NPI Number	:	1396714994
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALLISON MARIE LINQUIST M.D.

Provider Business Mailing Address
First Line	:	8028 RITCHIE HWY
Second Line	:	SUITE 110
City	:	PASADENA
State	:	MD
Zip	:	21122-1075
Country	:	US
Telephone Number	:	410-766-0111
Fax Number	:	410-582-9155

Provider Business Practice Location Address
First Line	:	8028 RITCHIE HWY
Second Line	:	SUITE 110
City	:	PASADENA
State	:	MD
Zip	:	21122-1075
Country	:	US
Telephone Number	:	410-766-0111
Fax Number	:	410-582-9155

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

Provider Enumeration Date	:	03/16/2006
Last Update Date	:	07/08/2007

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