Provider Demographics
NPI:1881801009
Name:ORTHOPAEDIC AND RECONSTRUCTIVE SURGEONS OF SOUTHEASTERN NH
Entity type:Organization
Organization Name:ORTHOPAEDIC AND RECONSTRUCTIVE SURGEONS OF SOUTHEASTERN NH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:INGVARS
Authorized Official - Middle Name:J
Authorized Official - Last Name:VITTANDS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:603-749-5110
Mailing Address - Street 1:780 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-3412
Mailing Address - Country:US
Mailing Address - Phone:603-749-5110
Mailing Address - Fax:603-743-4765
Practice Address - Street 1:780 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-3412
Practice Address - Country:US
Practice Address - Phone:603-749-5110
Practice Address - Fax:603-743-4765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH4623174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH82200144Medicaid
NH82200144Medicaid