Provider Demographics
NPI:1679101687
Name:BVUTE, KUSHINGA MATILDA (MD, MPH)
Entity Type:Individual
Prefix:
First Name:KUSHINGA
Middle Name:MATILDA
Last Name:BVUTE
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:KUSHINGA
Other - Middle Name:MATILDA
Other - Last Name:JANDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 810
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03755-0810
Mailing Address - Country:US
Mailing Address - Phone:160-330-8146
Mailing Address - Fax:561-955-3577
Practice Address - Street 1:1 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03756-0001
Practice Address - Country:US
Practice Address - Phone:603-650-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-27
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL390200000X
NH23128207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program