Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 6958 | VT |
Y | 207Q00000X | Family Doctor | 6756 | NH |
NPI | 1003838210 |
---|---|
Provider Name | Dr. George Alan Idelkope |
First Address | Chesterfield, NH 03443-3815 |
Second Address | Hinsdale, NH 03451 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2006 |
Last Update Date | 11/07/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00005673 | BLUE CROSS BLUE SHIELD VT (01) | VT |
0005673 | (05) | VT |
0100563YPNH01 | ANTHEM (01) | NH |
5777219 | AETNA (01) | |
82080563 | (05) | NE |
A68103 | (02) |