Provider Demographics
NPI:1467477380
Name:BLANCHETTE PORTER, MISTY MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:MISTY
Middle Name:MARIE
Last Name:BLANCHETTE PORTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1 MEDICAL CENTER DR
Mailing Address - Street 2:DEPARTMENT OB/GYN
Mailing Address - City:LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03756-1000
Mailing Address - Country:US
Mailing Address - Phone:603-653-9240
Mailing Address - Fax:603-650-0905
Practice Address - Street 1:1 MEDICAL CENTER DR
Practice Address - Street 2:DEPARTMENT OB/GYN
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03756-1000
Practice Address - Country:US
Practice Address - Phone:603-653-9240
Practice Address - Fax:802-650-0905
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NH8749207VE0102X
VT042-0008516207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0VN092Medicaid
NH80003976Medicaid
NH80003976Medicaid
F64212Medicare PIN