Provider Demographics
NPI:1659427490
Name:WHITE MOUNTAIN RADIOLOGY, P.C.
Entity Type:Organization
Organization Name:WHITE MOUNTAIN RADIOLOGY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRAFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:603-444-9577
Mailing Address - Street 1:LITTLETON REGIONAL HOSPITAL
Mailing Address - Street 2:600 ST. JOHNSBURY ROAD
Mailing Address - City:LITTLETON
Mailing Address - State:NH
Mailing Address - Zip Code:03561
Mailing Address - Country:US
Mailing Address - Phone:603-444-9577
Mailing Address - Fax:
Practice Address - Street 1:LITTLETON REGIONAL HOSPITAL
Practice Address - Street 2:600 ST. JOHNSBURY ROAD
Practice Address - City:LITTLETON
Practice Address - State:NH
Practice Address - Zip Code:03561
Practice Address - Country:US
Practice Address - Phone:603-444-9577
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH118632085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH01Y004716NH01OtherANTHEM
NH30212281Medicaid
NHRE7145Medicare ID - Type Unspecified