Provider Demographics
NPI:1770691263
Name:TILTON MEDICAL ASSOCIATES, PLLC
Entity type:Organization
Organization Name:TILTON MEDICAL ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:ROXANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRAMHALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-286-8907
Mailing Address - Street 1:243 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:TILTON
Mailing Address - State:NH
Mailing Address - Zip Code:03276
Mailing Address - Country:US
Mailing Address - Phone:603-286-8907
Mailing Address - Fax:603-286-8860
Practice Address - Street 1:243 MAIN ST
Practice Address - Street 2:
Practice Address - City:TILTON
Practice Address - State:NH
Practice Address - Zip Code:03276-5112
Practice Address - Country:US
Practice Address - Phone:603-286-8907
Practice Address - Fax:603-286-8860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-26
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH6029173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3000534Medicaid
NH8108689Medicaid
RE9009Medicare PIN
NHB98054Medicare UPIN
NH8108689Medicaid
NHSX4913Medicare PIN