Provider Demographics
NPI:1154786804
Name:NORTH COUNTRY GASTROENTEROLOGY
Entity type:Organization
Organization Name:NORTH COUNTRY GASTROENTEROLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:S
Authorized Official - Last Name:MITZ
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:603-444-0272
Mailing Address - Street 1:220 COTTAGE ST
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:NH
Mailing Address - Zip Code:03561-4101
Mailing Address - Country:US
Mailing Address - Phone:603-444-0272
Mailing Address - Fax:603-444-0274
Practice Address - Street 1:220 COTTAGE ST
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:NH
Practice Address - Zip Code:03561-4101
Practice Address - Country:US
Practice Address - Phone:603-444-0272
Practice Address - Fax:603-444-0274
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTH COUNTRY GASTROENTEROLOGY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-12-23
Last Update Date:2015-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH9856207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3083147Medicaid
NH3083147Medicaid