Provider Demographics
NPI:1144209230
Name:EYE ANESTHESIA OF CONCORD PLLC
Entity Type:Organization
Organization Name:EYE ANESTHESIA OF CONCORD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:EILEEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:SERRATORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-228-1104
Mailing Address - Street 1:246 PLEASANT ST
Mailing Address - Street 2:SUITE 105 B
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-2548
Mailing Address - Country:US
Mailing Address - Phone:603-224-6503
Mailing Address - Fax:
Practice Address - Street 1:246 PLEASANT ST
Practice Address - Street 2:SUITE 105 B
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-2548
Practice Address - Country:US
Practice Address - Phone:603-224-6503
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-17
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30211319Medicaid
NH57942OtherCIGNA GROUP ID
NHCH6643OtherRR MEDICARE GROUP ID
NH57942OtherCIGNA GROUP ID