Provider Demographics
NPI:1093820821
Name:HORT, SHOSHANA JENNIFER (MD)
Entity Type:Individual
Prefix:DR
First Name:SHOSHANA
Middle Name:JENNIFER
Last Name:HORT
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Gender:F
Credentials:MD
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Mailing Address - Street 1:1 MEDICAL CENTER DR
Mailing Address - Street 2:DHMC DEPARTMENT OF GENERAL INTERNAL MEDICINE
Mailing Address - City:LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03756-1000
Mailing Address - Country:US
Mailing Address - Phone:603-653-9500
Mailing Address - Fax:603-653-9386
Practice Address - Street 1:1 MEDICAL CENTER DR
Practice Address - Street 2:DHMC DEPARTMENT OF GENERAL INTERNAL MEDICINE
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03756-1000
Practice Address - Country:US
Practice Address - Phone:603-653-9500
Practice Address - Fax:603-653-9386
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2011-07-18
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Provider Licenses
StateLicense IDTaxonomies
PAMD426138207R00000X
NH13961207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1013911800001Medicaid
VT1015166Medicaid
NH30207917Medicaid
I36670Medicare UPIN
NH30207917Medicaid