Provider Demographics
NPI:1205813086
Name:OETKING, MAUDE (MD)
Entity Type:Individual
Prefix:DR
First Name:MAUDE
Middle Name:
Last Name:OETKING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MAUDE
Other - Middle Name:OETKING
Other - Last Name:KEESHIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:173 MIDDLE ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:NH
Mailing Address - Zip Code:03584-3508
Mailing Address - Country:US
Mailing Address - Phone:603-788-5029
Mailing Address - Fax:603-788-5027
Practice Address - Street 1:170 MIDDLE ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:NH
Practice Address - Zip Code:03584-3556
Practice Address - Country:US
Practice Address - Phone:603-788-2521
Practice Address - Fax:603-788-5027
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2017-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH10534208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3073542Medicaid
VTOVN1083Medicaid
NHRE5325Medicare ID - Type Unspecified
VTOVN1083Medicaid