Provider Demographics
NPI:1003200767
Name:JANE SULLIVAN-DURAND MD
Entity Type:Organization
Organization Name:JANE SULLIVAN-DURAND MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JANE
Authorized Official - Middle Name:
Authorized Official - Last Name:SULLIVAN-DURAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:603-746-4626
Mailing Address - Street 1:633 MAPLE STREET, SUITE 1, BOX 2
Mailing Address - Street 2:
Mailing Address - City:CONTOOCOOK
Mailing Address - State:NH
Mailing Address - Zip Code:03229-3377
Mailing Address - Country:US
Mailing Address - Phone:603-746-4626
Mailing Address - Fax:603-746-1133
Practice Address - Street 1:633 MAPLE STREET, SUITE 1
Practice Address - Street 2:
Practice Address - City:CONTOOCOOK
Practice Address - State:NH
Practice Address - Zip Code:03229-3377
Practice Address - Country:US
Practice Address - Phone:603-746-4626
Practice Address - Fax:603-746-1133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-20
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH7856207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHA72475Medicare UPIN