MEDICARE: ROBERT THIES MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0400X	Neurology Physician	6531	NH
2	2084N0400X	Neurology Physician	77799	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962487769
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT THIES MD

Provider Business Mailing Address
First Line	:	769 S MAIN ST
Second Line	:
City	:	MANCHESTER
State	:	NH
Zip	:	03102-5166
Country	:	US
Telephone Number	:	603-669-0859
Fax Number	:	603-644-3391

Provider Business Practice Location Address
First Line	:	769 S MAIN ST
Second Line	:
City	:	MANCHESTER
State	:	NH
Zip	:	03102-5166
Country	:	US
Telephone Number	:	603-669-0859
Fax Number	:	603-644-3391

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/14/2005
Last Update Date	:	01/19/2011

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