Provider Demographics
NPI:1093751018
Name:TUTTLE, BENJAMIN (MD)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:TUTTLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87 SPRING ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LACONIA
Mailing Address - State:NH
Mailing Address - Zip Code:03246-3135
Mailing Address - Country:US
Mailing Address - Phone:603-524-3211
Mailing Address - Fax:603-524-0089
Practice Address - Street 1:87 SPRING ST
Practice Address - Street 2:SUITE 101
Practice Address - City:LACONIA
Practice Address - State:NH
Practice Address - Zip Code:03246-3135
Practice Address - Country:US
Practice Address - Phone:603-524-3211
Practice Address - Fax:603-524-0089
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH63672085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH00000604Medicaid
NH0104493YONH01OtherANTHEM
NH2670OtherCIGNA
E10040Medicare UPIN
NH00000604Medicaid