Provider Demographics
NPI:1760476667
Name:ITKIN, DAVID J (MD)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:J
Last Name:ITKIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:330 BORTHWICK AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-4174
Mailing Address - Country:US
Mailing Address - Phone:603-433-8733
Mailing Address - Fax:603-433-8834
Practice Address - Street 1:330 BORTHWICK AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-4174
Practice Address - Country:US
Practice Address - Phone:603-433-8733
Practice Address - Fax:603-433-8834
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME016418207RI0200X
NH8392208000000X, 207RI0200X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3082964Medicaid
NHVX0233Medicare PIN
NHB90886Medicare UPIN
NH3082964Medicaid
NHP00288792Medicare PIN
NHVX0233Medicare PIN