Healthcare Provider Details

I. General information

NPI: 1205813086
Provider Name (Legal Business Name): MAUDE OETKING MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MAUDE OETKING KEESHIN MD

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 08/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 MIDDLE ST
LANCASTER NH
03584-3556
US

IV. Provider business mailing address

173 MIDDLE ST
LANCASTER NH
03584-3508
US

V. Phone/Fax

Practice location:
  • Phone: 603-788-2521
  • Fax: 603-788-5027
Mailing address:
  • Phone: 603-788-5029
  • Fax: 603-788-5027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number10534
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: