Provider Demographics
NPI:1033290994
Name:GARRISON MEDICAL PROFESSIONAL ASSOCIATION
Entity Type:Organization
Organization Name:GARRISON MEDICAL PROFESSIONAL ASSOCIATION
Other - Org Name:GARRISON WOMEN'S HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:S
Authorized Official - Last Name:BERTRAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:603-742-0101
Mailing Address - Street 1:770 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-3437
Mailing Address - Country:US
Mailing Address - Phone:603-742-0101
Mailing Address - Fax:603-743-3171
Practice Address - Street 1:770 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-3437
Practice Address - Country:US
Practice Address - Phone:603-742-0101
Practice Address - Fax:603-743-3171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME138620000Medicaid
NH200010998OtherMVP
NH81163629Medicaid
NH81163629Medicaid