Basic Information
| Provider Information | |||||||||
| NPI: | 1366476541 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TRINKL | ||||||||
| FirstName: | OTTO | ||||||||
| MiddleName: | WILHELM | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 590 COURT ST | ||||||||
| Address2: | |||||||||
| City: | KEENE | ||||||||
| State: | NH | ||||||||
| PostalCode: | 034311719 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6033545454 | ||||||||
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| Practice Location | |||||||||
| Address1: | 590 COURT ST | ||||||||
| Address2: | |||||||||
| City: | KEENE | ||||||||
| State: | NH | ||||||||
| PostalCode: | 034311719 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6033545454 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2006 | ||||||||
| LastUpdateDate: | 03/30/2012 | ||||||||
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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 | 207RG0100X | 11979 | NH | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | 207RG0100X | 23533 | CO | N | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | 207RG0100X | ME55806 | FL | N | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | 207RG0100X | 021892 | GA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | 207RG0100X | 05215R | LA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | 207RG0100X | F9045 | TX | N | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 30203339 | 05 | NH | MEDICAID |