Provider Demographics
NPI:1780671388
Name:PAINE, JUDITH HOWARD (MD)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:HOWARD
Last Name:PAINE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 DERRY RD
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:NH
Mailing Address - Zip Code:03051-3023
Mailing Address - Country:US
Mailing Address - Phone:603-579-5472
Mailing Address - Fax:603-594-8754
Practice Address - Street 1:300 DERRY RD
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:NH
Practice Address - Zip Code:03051-3023
Practice Address - Country:US
Practice Address - Phone:603-579-5472
Practice Address - Fax:603-594-8754
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH7817207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH80009649Medicaid
NHD78741Medicare UPIN