1275525545 NPI number — DR. ARNOLD J WILLIS MD

Table of content: DR. ARNOLD J WILLIS MD (NPI 1275525545)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275525545 NPI number — DR. ARNOLD J WILLIS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILLIS
Provider First Name:
ARNOLD
Provider Middle Name:
J
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1275525545
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/25/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
590 COURT ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KEENE
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03431-1719
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-354-5400
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
590 COURT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KEENE
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03431-1719
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-354-5400
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/22/2005

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: 208800000X , with the licence number:  85836 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208800000X , with the licence number: TL6077 , registered in the state of WY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208800000X , with the licence number: MD9513 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208800000X , with the licence number: D0020464 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208800000X , with the licence number: LT4196 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1095850 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 028055 . This is a "JOHN HOPKINS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1901104 . This is a "UNITED HEALTHCARE AMERICHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00439848 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 023376900 , issued by the state of ( DC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 028055 . This is a "PRIORITY PARTNERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1467393 . This is a "AETNA HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 35301905 . This is a "BCBS MD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 57620005 . This is a "BCBS DC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4053748 . This is a "AETNA PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 35301902 . This is a "BCBS MD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 45428 . This is a "OPTIMUM CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 432105237 . This is a "BRAVO HEALTH" identifier . This identifiers is of the category "OTHER".




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