Healthcare Provider Details

I. General information

NPI: 1396123790
Provider Name (Legal Business Name): MACKENZIE BARTLETT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2015
Last Update Date: 01/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 ELLIOT WAY
MANCHESTER NH
03103
US

IV. Provider business mailing address

1 ELLIOT WAY
MANCHESTER NH
03103-3502
US

V. Phone/Fax

Practice location:
  • Phone: 603-663-2710
  • Fax:
Mailing address:
  • Phone: 603-663-2710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberLP03443
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number18779
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: