=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205037801
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TIPTON HARTMAN-HEANEY D.O.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/30/2007
-----------------------------------------------------
Last Update Date | 11/13/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 ELLIOT WAY ELLIOT INTENSIVISTS
-----------------------------------------------------
City | MANCHESTER
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03103-3502
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-663-2231
-----------------------------------------------------
Fax | 603-663-2353
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1 ELLIOT WAY ELLIOT INTENSIVISTS
-----------------------------------------------------
City | MANCHESTER
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03103-3502
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-663-2231
-----------------------------------------------------
Fax | 603-663-2353
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0200X
-----------------------------------------------------
Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
-----------------------------------------------------
License Number | 036144619
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RC0200X
-----------------------------------------------------
Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
-----------------------------------------------------
License Number | LT-3186
-----------------------------------------------------
License Number State | NH
-----------------------------------------------------