Provider Demographics
NPI:1760588032
Name:HOUT, PICH (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:PICH
Middle Name:
Last Name:HOUT
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 BEAR PATH LN
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:NH
Mailing Address - Zip Code:03051-6403
Mailing Address - Country:US
Mailing Address - Phone:978-737-6161
Mailing Address - Fax:978-937-6894
Practice Address - Street 1:295 VARNUM AVE
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01854-2134
Practice Address - Country:US
Practice Address - Phone:978-737-6161
Practice Address - Fax:978-937-6894
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA865363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAAP168401Medicare PIN