Provider Demographics
NPI:1982609079
Name:WEST, JOHN LEWIS (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:LEWIS
Last Name:WEST
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 1:243 ELM STREET
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:NH
Mailing Address - Zip Code:03743
Mailing Address - Country:US
Mailing Address - Phone:603-863-6400
Mailing Address - Fax:603-863-7800
Practice Address - Street 1:11 JOHN STARK HIGHWAY SUITE 1A
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:NH
Practice Address - Zip Code:03773
Practice Address - Country:US
Practice Address - Phone:603-863-6400
Practice Address - Fax:603-863-7800
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2016-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH6084207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3079322Medicaid
VT1001213Medicaid
NHE40371Medicare UPIN
RE0960Medicare ID - Type Unspecified
VT1001213Medicaid
NH0105053YPNH01OtherANTHEM