Provider Demographics
NPI:1609802271
Name:DEGUZMAN, VITALI H (MD)
Entity Type:Individual
Prefix:
First Name:VITALI
Middle Name:H
Last Name:DEGUZMAN
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:PO BOX 847056
Mailing Address - Street 2:NASHUA ANESTHESIA PARTNERS
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02284-7056
Mailing Address - Country:US
Mailing Address - Phone:800-720-1664
Mailing Address - Fax:207-753-2020
Practice Address - Street 1:8 PROSPECT ST
Practice Address - Street 2:ANESTHESIA DEPARTMENT
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060-3925
Practice Address - Country:US
Practice Address - Phone:603-889-2624
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH6693207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30001228Medicaid
NH30001228Medicaid
NHNH8698Medicare PIN
A30354Medicare UPIN