Healthcare Provider Details

I. General information

NPI: 1770691263
Provider Name (Legal Business Name): TILTON MEDICAL ASSOCIATES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2006
Last Update Date: 05/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

243 MAIN ST
TILTON NH
03276-5112
US

IV. Provider business mailing address

243 MAIN STREET
TILTON NH
03276
US

V. Phone/Fax

Practice location:
  • Phone: 603-286-8907
  • Fax: 603-286-8860
Mailing address:
  • Phone: 603-286-8907
  • Fax: 603-286-8860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number6029
License Number StateNH

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier3000534
Identifier TypeMEDICAID
Identifier StateNH
Identifier Issuer
# 2
Identifier8108689
Identifier TypeMEDICAID
Identifier StateNH
Identifier Issuer

VIII. Authorized Official

Name: ROXANNE BRAMHALL
Title or Position: ADMINISTRATIVE ASSISTANT
Credential:
Phone: 603-286-8907