MEDICARE: DR. ARNOLD J WILLIS 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	208800000X	Urology Physician	85836	GA
2	208800000X	Urology Physician	TL6077	WY
3	208800000X	Urology Physician	MD9513	DC
4	208800000X	Urology Physician	D0020464	MD
5	208800000X	Urology Physician	LT4196	NH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	P00439848	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	1095850	OTHER	CIGNA
2	028055	OTHER	JOHN HOPKINS
3	1901104	OTHER	UNITED HEALTHCARE AMERICHOICE
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	028055	OTHER	PRIORITY PARTNERS
7	1467393	OTHER	AETNA HMO
8	35301905	OTHER	BCBS MD
9	57620005	OTHER	BCBS DC
10	4053748	OTHER	AETNA PPO
11	35301902	OTHER	BCBS MD
12	45428	OTHER	OPTIMUM CHOICE
13	432105237	OTHER	BRAVO HEALTH

General Provider Information

NPI Number	:	1275525545
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ARNOLD J WILLIS MD

Provider Business Mailing Address
First Line	:	590 COURT ST
Second Line	:
City	:	KEENE
State	:	NH
Zip	:	03431-1719
Country	:	US
Telephone Number	:	603-354-5400
Fax Number	:

Provider Business Practice Location Address
First Line	:	590 COURT ST
Second Line	:
City	:	KEENE
State	:	NH
Zip	:	03431-1719
Country	:	US
Telephone Number	:	603-354-5400
Fax Number	:

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

Provider Enumeration Date	:	08/22/2005
Last Update Date	:	06/25/2020

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