Provider Demographics
NPI:1164462651
Name:ANTINERELLA, NICOLE (DO)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:
Last Name:ANTINERELLA
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 1:246 PLEASANT ST
Mailing Address - Street 2:MEMORIAL BUILDING, WEST, FLOOR 2
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-2548
Mailing Address - Country:US
Mailing Address - Phone:603-224-4003
Mailing Address - Fax:603-227-7526
Practice Address - Street 1:246 PLEASANT ST
Practice Address - Street 2:MEMORIAL BUILDING, WEST, FLOOR 2
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-2548
Practice Address - Country:US
Practice Address - Phone:603-224-4003
Practice Address - Fax:603-227-7526
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH12690207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHI34518Medicare UPIN