Basic Information
| Provider Information | |||||||||
| NPI: | 1326120619 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GUILTINAN | ||||||||
| FirstName: | MATTTHEW | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 590 COURT ST | ||||||||
| Address2: | CHESHIRE MEDICAL CENTER | ||||||||
| City: | KEENE | ||||||||
| State: | NH | ||||||||
| PostalCode: | 034311719 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6033545400 | ||||||||
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| Practice Location | |||||||||
| Address1: | 590 COURT ST | ||||||||
| Address2: | CHESHIRE MEDICAL CENTER | ||||||||
| City: | KEENE | ||||||||
| State: | NH | ||||||||
| PostalCode: | 034311719 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6033545400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/19/2006 | ||||||||
| LastUpdateDate: | 03/29/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 8390 | NH | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 30202098 | 05 | NH | MEDICAID |