Provider Demographics
NPI:1730292103
Name:KAITZ, STEVEN H (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:H
Last Name:KAITZ
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 1:48 GLASS ST
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE
Mailing Address - State:NH
Mailing Address - Zip Code:03275-1506
Mailing Address - Country:US
Mailing Address - Phone:603-485-7788
Mailing Address - Fax:
Practice Address - Street 1:48 GLASS ST
Practice Address - Street 2:
Practice Address - City:PEMBROKE
Practice Address - State:NH
Practice Address - Zip Code:03275-1506
Practice Address - Country:US
Practice Address - Phone:603-485-7788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH7616207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH0105530YPNH01OtherANTHEM
NH40002830Medicaid
NH0105530YPNH01OtherANTHEM
NHKARE1265Medicare ID - Type Unspecified