Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | ML20008350 | WA |
Y | 2080P0203X | Pediatric Critical Care Doctor | 15905 | NH |
N | 2080P0203X | Pediatric Critical Care Doctor | LT-3189 | NH |
NPI | 1033122502 |
---|---|
Provider Name | Omar J Bhutta |
First Address | Lebanon, NH 03756-1000 |
Second Address | Lebanon, NH 03756-1000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2006 |
Last Update Date | 08/03/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1021010 | (05) | VT |
32001711 | (05) | NH |