1467477380 NPI number — DR. MISTY MARIE BLANCHETTE PORTER M.D.

Table of content: DR. MISTY MARIE BLANCHETTE PORTER M.D. (NPI 1467477380)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467477380 NPI number — DR. MISTY MARIE BLANCHETTE PORTER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BLANCHETTE PORTER
Provider First Name:
MISTY
Provider Middle Name:
MARIE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

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:
1467477380
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/12/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 MEDICAL CENTER DR
Provider Second Line Business Mailing Address:
DEPARTMENT OB/GYN
Provider Business Mailing Address City Name:
LEBANON
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03756-1000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-653-9240
Provider Business Mailing Address Fax Number:
603-650-0905

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 MEDICAL CENTER DR
Provider Second Line Business Practice Location Address:
DEPARTMENT OB/GYN
Provider Business Practice Location Address City Name:
LEBANON
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03756-1000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-653-9240
Provider Business Practice Location Address Fax Number:
802-650-0905
Provider Enumeration Date:
07/13/2006

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: 207VE0102X , with the licence number:  8749 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207VE0102X , with the licence number: 042-0008516 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0VN092 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 80003976 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".




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