Provider Demographics
NPI:1093129611
Name:OLSEN, DAMIAN (MD)
Entity Type:Individual
Prefix:
First Name:DAMIAN
Middle Name:
Last Name:OLSEN
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 1:88 MCGREGOR ST STE 201
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03102-3733
Mailing Address - Country:US
Mailing Address - Phone:603-314-7595
Mailing Address - Fax:
Practice Address - Street 1:88 MCGREGOR ST STE 201
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03102-3733
Practice Address - Country:US
Practice Address - Phone:603-314-7595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-12
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014018100207V00000X
NE30842207V00000X
NH19599207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty