Provider Demographics
NPI:1194717728
Name:POTT-GRINSTEIN, ELISABETH A (MD)
Entity type:Individual
Prefix:DR
First Name:ELISABETH
Middle Name:A
Last Name:POTT-GRINSTEIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 310
Mailing Address - Street 2:
Mailing Address - City:LACONIA
Mailing Address - State:NH
Mailing Address - Zip Code:03247-0310
Mailing Address - Country:US
Mailing Address - Phone:603-524-3211
Mailing Address - Fax:603-527-7038
Practice Address - Street 1:734 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:LACONIA
Practice Address - State:NH
Practice Address - Zip Code:03246-2777
Practice Address - Country:US
Practice Address - Phone:603-527-1855
Practice Address - Fax:603-527-1872
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME81196207V00000X
NH11428207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH32000061Medicaid
G96831Medicare UPIN
NH32000061Medicaid