Provider Demographics
NPI:1164425641
Name:ELGERT, STEPHEN D (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:D
Last Name:ELGERT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:15 CONSTITUTION DR
Mailing Address - Street 2:ELLIOT FAMILY MEDICINE AT BEDFORD VILLAGE
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110-6042
Mailing Address - Country:US
Mailing Address - Phone:603-472-7233
Mailing Address - Fax:603-472-9188
Practice Address - Street 1:15 CONSTITUTION DR
Practice Address - Street 2:ELLIOT FAMILY MEDICINE AT BEDFORD VILLAGE
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110-6042
Practice Address - Country:US
Practice Address - Phone:603-472-7233
Practice Address - Fax:603-472-9188
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NH6668207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH80300001Medicaid
NHRE5418Medicare ID - Type Unspecified
NH80300001Medicaid