Provider Demographics
NPI:1962487769
Name:THIES, ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:THIES
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 1:769 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03102-5166
Mailing Address - Country:US
Mailing Address - Phone:603-669-0859
Mailing Address - Fax:603-644-3391
Practice Address - Street 1:769 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03102-5166
Practice Address - Country:US
Practice Address - Phone:603-669-0859
Practice Address - Fax:603-644-3391
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH65312084N0400X
MA777992084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH81130401Medicaid
NH81130401Medicaid
NHE34500Medicare ID - Type Unspecified