1679540165 NPI number — DR. CLARE WILMOT M.D.

Table of content: DR. CLARE WILMOT M.D. (NPI 1679540165)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679540165 NPI number — DR. CLARE WILMOT M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILMOT
Provider First Name:
CLARE
Provider Middle Name:
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:
1679540165
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/03/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
580 SAINT JOHNSBURY RD STE K
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LITTLETON
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03561-3439
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-444-2010
Provider Business Mailing Address Fax Number:
603-444-2181

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
580 SAINT JOHNSBURY RD
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
LITTLETON
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03561
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-444-0997
Provider Business Practice Location Address Fax Number:
603-444-6038
Provider Enumeration Date:
03/02/2006

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: 208600000X , with the licence number:  9789 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: 9789 , 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: 29072 . This is a "CIGNA" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 1003089 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 29171 . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: AA37642 . This is a "HARVARD PILGRIM HEALTHCAR" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 3094267 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 788823 . This is a "MVP" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 80300008 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0100183Y0NH01 . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: AA55615 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".




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