Provider Demographics
NPI:1083780324
Name:PORTSMOUTH PRIMARY CARE ASSO
Entity Type:Organization
Organization Name:PORTSMOUTH PRIMARY CARE ASSO
Other - Org Name:LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:P
Authorized Official - Last Name:CLAIRMONT
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:603-436-5455
Mailing Address - Street 1:330 BORTHWICK AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801
Mailing Address - Country:US
Mailing Address - Phone:603-436-5455
Mailing Address - Fax:603-433-1985
Practice Address - Street 1:330 BORTHWICK AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801
Practice Address - Country:US
Practice Address - Phone:603-436-5455
Practice Address - Fax:603-433-1985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30210770Medicaid
NH30210770Medicaid