Individual
KEITH SHUTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
59 PAGE HILL RD, BERLIN, NH 03570-3531
(603) 752-2900
(603) 752-3727
Mailing address
133 PLEASANT ST, BERLIN, NH 03570-2006
(603) 752-2040
(603) 752-1709
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
9083
NH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0109410YPNH02
ANTHEM BC/BS
NH
05
—
3072597
—
NH
01
—
3626045001
CIGNA HEALTHCARE
NH
01
—
5830418
AETNA GROUP
—
01
—
9083
STATE LICENSE #
NH
05
—
99003818
—
NH
01
—
P00100702
RAILROAD MEDICARE
—
01
—
RE289602
PTAN MEDICARE
—
01
—
RE7915
MEDICARE GROUP PTAN
—
Enumeration date
08/12/2005
Last updated
03/07/2023
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