Provider Demographics
NPI:1124006374
Name:OTERI-AHMADPOUR, CONCETTA ROSE (DO)
Entity Type:Individual
Prefix:MS
First Name:CONCETTA
Middle Name:ROSE
Last Name:OTERI-AHMADPOUR
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 OLD NASHUA RD
Mailing Address - Street 2:UNIT 14
Mailing Address - City:AMHERST
Mailing Address - State:NH
Mailing Address - Zip Code:03031
Mailing Address - Country:US
Mailing Address - Phone:603-673-1181
Mailing Address - Fax:603-673-0007
Practice Address - Street 1:31 OLD NASHUA RD
Practice Address - Street 2:UNIT 14
Practice Address - City:AMHERST
Practice Address - State:NH
Practice Address - Zip Code:03031
Practice Address - Country:US
Practice Address - Phone:603-673-1181
Practice Address - Fax:603-673-0007
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-07
Last Update Date:2014-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH12549207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30223103Medicaid
NH30223103Medicaid
I15166Medicare UPIN