Provider Demographics
NPI:1164510459
Name:GANEM, DEBORAH JEAN (MD)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:JEAN
Last Name:GANEM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:DEBORAH
Other - Middle Name:GANEM
Other - Last Name:YON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 3677
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03061-3677
Mailing Address - Country:US
Mailing Address - Phone:603-577-7900
Mailing Address - Fax:603-577-7972
Practice Address - Street 1:10 JONES RD
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:NH
Practice Address - Zip Code:03055-3100
Practice Address - Country:US
Practice Address - Phone:603-672-7600
Practice Address - Fax:603-672-6274
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH11733207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30203344Medicaid
H71270Medicare UPIN