Provider Demographics
NPI:1538201009
Name:OIDTMANN, ERNST M (MD)
Entity type:Individual
Prefix:
First Name:ERNST
Middle Name:M
Last Name:OIDTMANN
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 1:252 MECHANIC ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03766-2613
Mailing Address - Country:US
Mailing Address - Phone:603-448-1941
Mailing Address - Fax:603-448-6059
Practice Address - Street 1:252 MECHANIC ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03766-2613
Practice Address - Country:US
Practice Address - Phone:603-448-1941
Practice Address - Fax:603-448-6059
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH6030207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH0000458Medicaid
NH00006881OtherVT BLUE SHIELD
NH8744837OtherCIGNA
NHB86027OtherHARVARD PILGRIM
NH00006881OtherVT BLUE SHIELD
NH0000458Medicaid