Provider Demographics
NPI:1225089022
Name:DETWILLER, THOMAS H (DPM)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:H
Last Name:DETWILLER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:248 PLEASANT ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-2588
Mailing Address - Country:US
Mailing Address - Phone:603-225-5281
Mailing Address - Fax:603-228-7095
Practice Address - Street 1:248 PLEASANT ST
Practice Address - Street 2:SUITE 203
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-2588
Practice Address - Country:US
Practice Address - Phone:603-225-5281
Practice Address - Fax:603-228-7095
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0290213EP1101X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30360588Medicaid
NHU72695Medicare UPIN
NHRE5683Medicare ID - Type Unspecified