Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 9686 | NH |
NPI | 1003841594 |
---|---|
Provider Name | Dr. Leslie Thomas Pitts |
First Address | Keene, NH 03431-1719 |
Second Address | Keene, NH 03431-1719 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2006 |
Last Update Date | 26/03/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
30009583 | (05) | NH |
G26262 | (02) |