1528028610 NPI number — DR. JOHN P HOUDE MD

Table of content: DR. JOHN P HOUDE MD (NPI 1528028610)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528028610 NPI number — DR. JOHN P HOUDE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOUDE
Provider First Name:
JOHN
Provider Middle Name:
P
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:
1528028610
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/29/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10 ALICE PECK DAY DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEBANON
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03766-2694
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-448-3121
Provider Business Mailing Address Fax Number:
603-448-7462

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10 ALICE PECK DAY DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEBANON
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03766-2900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-442-5630
Provider Business Practice Location Address Fax Number:
603-446-7469
Provider Enumeration Date:
03/24/2006

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: 207X00000X , with the licence number:  0420010413 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207X00000X , with the licence number: 11504 , 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: F75854 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 602933 . This is a "MVP" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 01Y004009NH01 . This is a "ANTHEM BC/BS OF NEW HAMPSHIRE" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 1387569 . This is a "CIGNA HEALTHCARE" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 30203221 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1009003 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 421539118 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 58952 . This is a "BCVT" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 2972483 . This is a "AETNA" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".




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