Basic Information
| Provider Information | |||||||||
| NPI: | 1790277796 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VIKTORSSON | ||||||||
| FirstName: | SINDRI | ||||||||
| MiddleName: | ARON | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | DARTMOUTH- HITCHCOCK MEDICAL CENTER | ||||||||
| Address2: | ONE MEDICAL CENTER DR | ||||||||
| City: | LEBANON | ||||||||
| State: | NH | ||||||||
| PostalCode: | 03756 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6036505869 | ||||||||
| FaxNumber: | 6036505754 | ||||||||
| Practice Location | |||||||||
| Address1: | DARTMOUTH- HITCHCOCK MEDICAL CENTER | ||||||||
| Address2: | ONE MEDICAL CENTER DR | ||||||||
| City: | LEBANON | ||||||||
| State: | NH | ||||||||
| PostalCode: | 03756 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6036505869 | ||||||||
| FaxNumber: | 6036505754 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2018 | ||||||||
| LastUpdateDate: | 03/05/2019 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | 01/25/2019 | ||||||||
| NPIReactivationDate: | 03/05/2019 | ||||||||
| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.