Provider Demographics
NPI:1831209600
Name:WIRTH, LAUREN ANNE GEDDES (MD)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:ANNE GEDDES
Last Name:WIRTH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:ANNE
Other - Last Name:GEDDES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:273 COUNTY RD
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:NH
Mailing Address - Zip Code:03257-7700
Mailing Address - Country:US
Mailing Address - Phone:603-526-2911
Mailing Address - Fax:
Practice Address - Street 1:273 COUNTY RD
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:NH
Practice Address - Zip Code:03257-7700
Practice Address - Country:US
Practice Address - Phone:603-526-2911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA797692080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F93338Medicare UPIN
9708481Medicare ID - Type Unspecified