Linda Boettger, PA
Individual provider Active NPI Medical Physician Assistant · Greeenville, NC
NPI 1720064181 · NPPES record last updated Apr 19, 2010
Key facts
- NPI
- 1720064181
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Medical Physician Assistant 363AM0700X
- License
- 100819 (NC)
- Practice address
- 600 Moye Blvd
Brody Outpatient Center
Greeenville, NC 27858 - Phone
- (252) 744-2207
- Fax
- (252) 744-3224
- NPI assigned
- Dec 19, 2005
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 100819 | NC | Yes |
Addresses
Primary practice location
600 Moye Blvd
Brody Outpatient Center
Greeenville, NC 27858
Mailing address
PO Box 751069
Charlotte, NC 28275-1069
Phone (252) 744-3235
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 970005603 | Other | NC | RAILROAD MEDICARE |
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 19, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.