Provider Demographics
NPI:1588666267
Name:SHUTE, KEITH (MD)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:
Last Name:SHUTE
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 1:133 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:NH
Mailing Address - Zip Code:03570-2006
Mailing Address - Country:US
Mailing Address - Phone:603-752-2040
Mailing Address - Fax:603-752-1709
Practice Address - Street 1:59 PAGE HILL RD
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:NH
Practice Address - Zip Code:03570-3531
Practice Address - Country:US
Practice Address - Phone:603-752-2900
Practice Address - Fax:603-752-3727
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH9083207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH9083OtherSTATE LICENSE #
NH0109410YPNH02OtherANTHEM BC/BS
NH3072597Medicaid
RE7915OtherMEDICARE GROUP PTAN
NH99003818Medicaid
RE289602OtherPTAN MEDICARE
NH3626045001OtherCIGNA HEALTHCARE
5830418OtherAETNA GROUP
P00100702OtherRAILROAD MEDICARE
P00100702OtherRAILROAD MEDICARE
RE289602OtherPTAN MEDICARE
NH3072597Medicaid