Provider Demographics
NPI:1649231762
Name:GINSBERG, EVAN M (MD)
Entity Type:Individual
Prefix:
First Name:EVAN
Middle Name:M
Last Name:GINSBERG
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:2006-03-29
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0420011723207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT758195OtherCONNECTICARE
CT0Q2049OtherHEALTHNET
CT110156074OtherRAILROAD MEDICARE
CT2047669OtherAETNA
NH32001123Medicaid
CTNHP069OtherOXFORD
CT010020709CT01OtherBLUE CROSS BLUE SHIELD
CT010020709CT01OtherBLUE CROSS BLUE SHIELD
CT110156074OtherRAILROAD MEDICARE
CTB38317Medicare UPIN