Provider Demographics
NPI:1447206198
Name:WITKIN, RONALD H (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:H
Last Name:WITKIN
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 1:85 SPRING ST
Mailing Address - Street 2:SUITE 503
Mailing Address - City:LACONIA
Mailing Address - State:NH
Mailing Address - Zip Code:03246-3113
Mailing Address - Country:US
Mailing Address - Phone:603-524-9201
Mailing Address - Fax:603-524-4338
Practice Address - Street 1:85 SPRING ST
Practice Address - Street 2:SUITE 503
Practice Address - City:LACONIA
Practice Address - State:NH
Practice Address - Zip Code:03246-3113
Practice Address - Country:US
Practice Address - Phone:603-524-9201
Practice Address - Fax:603-524-4338
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH5697207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
B85843OtherHARVARD PILGRIM HEALTH CA
0100132YPNH02OtherANTHEM
NH81110132Medicaid
0100132YPNH02OtherANTHEM
NH0132Medicare ID - Type Unspecified