Basic Information
| Provider Information | |||||||||
| NPI: | 1366686297 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | EILTS | ||||||||
| FirstName: | CAMERON | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | DPM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1900 LAFAYETTE RD | ||||||||
| Address2: | SUITE A | ||||||||
| City: | PORTSMOUTH | ||||||||
| State: | NH | ||||||||
| PostalCode: | 038015679 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6034311121 | ||||||||
| FaxNumber: | 6034319147 | ||||||||
| Practice Location | |||||||||
| Address1: | 1900 LAFAYETTE RD | ||||||||
| Address2: | SUITE A | ||||||||
| City: | PORTSMOUTH | ||||||||
| State: | NH | ||||||||
| PostalCode: | 038015679 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6034311121 | ||||||||
| FaxNumber: | 6034319147 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/22/2009 | ||||||||
| LastUpdateDate: | 02/23/2017 | ||||||||
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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 | 213E00000X | 0335 | NH | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist |
ID Information
| ID | Type | State | Issuer | Description | 30369262 | 05 | NH | MEDICAID |