Basic Information
| Provider Information | |||||||||
| NPI: | 1649231762 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GINSBERG | ||||||||
| FirstName: | EVAN | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 590 COURT ST | ||||||||
| Address2: | |||||||||
| City: | KEENE | ||||||||
| State: | NH | ||||||||
| PostalCode: | 034311719 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6033545400 | ||||||||
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| Practice Location | |||||||||
| Address1: | 590 COURT ST | ||||||||
| Address2: | |||||||||
| City: | KEENE | ||||||||
| State: | NH | ||||||||
| PostalCode: | 034311719 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6033545400 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/29/2006 | ||||||||
| LastUpdateDate: | 03/27/2012 | ||||||||
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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 | 0420011723 | VT | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 758195 | 01 | CT | CONNECTICARE | OTHER | 0Q2049 | 01 | CT | HEALTHNET | OTHER | 110156074 | 01 | CT | RAILROAD MEDICARE | OTHER | 2047669 | 01 | CT | AETNA | OTHER | 32001123 | 05 | NH | MEDICAID | NHP069 | 01 | CT | OXFORD | OTHER | 010020709CT01 | 01 | CT | BLUE CROSS BLUE SHIELD | OTHER |