1235656257 NPI number — SAMUEL OUTTEN STOKES DPT

Table of content: SAMUEL OUTTEN STOKES DPT (NPI 1235656257)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235656257 NPI number — SAMUEL OUTTEN STOKES DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STOKES
Provider First Name:
SAMUEL
Provider Middle Name:
OUTTEN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235656257
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
45 LYME RD STE 101
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HANOVER
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03755-1220
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-653-0040
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 ARBORETUM LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WHITE RIVER JUNCTION
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05001-3320
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-359-7400
Provider Business Practice Location Address Fax Number:
603-653-0041
Provider Enumeration Date:
08/30/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2251X0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 4269 . This is a "STATE LICENSE" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".




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