Provider Demographics
NPI:1275525545
Name:WILLIS, ARNOLD J (MD)
Entity Type:Individual
Prefix:DR
First Name:ARNOLD
Middle Name:J
Last Name:WILLIS
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 1:590 COURT ST
Mailing Address - Street 2:
Mailing Address - City:KEENE
Mailing Address - State:NH
Mailing Address - Zip Code:03431-1719
Mailing Address - Country:US
Mailing Address - Phone:603-354-5400
Mailing Address - Fax:
Practice Address - Street 1:590 COURT ST
Practice Address - Street 2:
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431-1719
Practice Address - Country:US
Practice Address - Phone:603-354-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA85836208800000X
WYTL6077208800000X
DCMD9513208800000X
MDD0020464208800000X
NHLT4196208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
1095850OtherCIGNA
028055OtherJOHN HOPKINS
1901104OtherUNITED HEALTHCARE AMERICHOICE
P00439848OtherRAILROAD MEDICARE
DC023376900Medicaid
028055OtherPRIORITY PARTNERS
1467393OtherAETNA HMO
35301905OtherBCBS MD
57620005OtherBCBS DC
4053748OtherAETNA PPO
35301902OtherBCBS MD
45428OtherOPTIMUM CHOICE
432105237OtherBRAVO HEALTH
DC023376900Medicaid
1901104OtherUNITED HEALTHCARE AMERICHOICE
028055OtherPRIORITY PARTNERS