Provider Demographics
NPI:1053479832
Name:POULIN, DENISE F (MD)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:F
Last Name:POULIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:590 COURT STREET
Mailing Address - Street 2:OBSTETRICS & GYNECOLOGY
Mailing Address - City:KEENE
Mailing Address - State:NH
Mailing Address - Zip Code:03431
Mailing Address - Country:US
Mailing Address - Phone:603-354-5400
Mailing Address - Fax:
Practice Address - Street 1:590 COURT STREET
Practice Address - Street 2:OBSTETRICS & GYNECOLOGY
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431
Practice Address - Country:US
Practice Address - Phone:603-354-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2017-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH14040207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTOVN1238Medicaid
NH3076898Medicaid
NH3076898Medicaid
VTOVN1238Medicaid