MEDICARE: DR. LINDA SUZETTE DEFRAHN D.O.

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	207Q00000X	Family Medicine Physician	8857	NH

General Provider Information

NPI Number	:	1760539449
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LINDA SUZETTE DEFRAHN D.O.

Provider Business Mailing Address
First Line	:	3855 DARTMOUTH COLLEGE HWY
Second Line	:
City	:	NORTH HAVERHILL
State	:	NH
Zip	:	03774-4909
Country	:	US
Telephone Number	:	603-787-6971
Fax Number	:	603-787-2035

Provider Business Practice Location Address
First Line	:	3855 DARTMOUTH COLLEGE HWY
Second Line	:
City	:	NORTH HAVERHILL
State	:	NH
Zip	:	03774-4909
Country	:	US
Telephone Number	:	603-787-6971
Fax Number	:	603-787-2035

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

Provider Enumeration Date	:	01/04/2007
Last Update Date	:	07/08/2007

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