Provider Demographics
NPI:1043291727
Name:EMMICK, GUS G (MD)
Entity Type:Individual
Prefix:
First Name:GUS
Middle Name:G
Last Name:EMMICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 CHAMBERS DR STE 2200
Mailing Address - Street 2:
Mailing Address - City:HOOKSETT
Mailing Address - State:NH
Mailing Address - Zip Code:03106-1981
Mailing Address - Country:US
Mailing Address - Phone:603-641-5386
Mailing Address - Fax:603-641-5387
Practice Address - Street 1:20 CHAMBERS DR STE 2200
Practice Address - Street 2:
Practice Address - City:HOOKSETT
Practice Address - State:NH
Practice Address - Zip Code:03106-1981
Practice Address - Country:US
Practice Address - Phone:603-641-5386
Practice Address - Fax:603-641-5387
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH11270208000000X, 207R00000X
MA285593208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH2575641OtherAETNA PIN
NHNH2088OtherHPHC PIN
NH112700OtherTUFTS PIN
NH01YP03155NH01OtherANTHEM ACES PIN
NH520230OtherCIGNA PIN
NH0443297OtherUHC PIN
NH990015540OtherRR MEDICARE PIN
NHH43842OtherANTHEM REFERRING UPIN
NH30201479Medicaid
NHNH2088OtherHPHC PIN
H43842Medicare UPIN