Provider Demographics
NPI:1174569644
Name:CONCORD GASTROENTEROLOGY PA
Entity type:Organization
Organization Name:CONCORD GASTROENTEROLOGY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARJORIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-228-1763
Mailing Address - Street 1:60 COMMERCIAL ST
Mailing Address - Street 2:SUITE 404
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-5071
Mailing Address - Country:US
Mailing Address - Phone:603-228-1763
Mailing Address - Fax:603-228-7088
Practice Address - Street 1:60 COMMERCIAL ST
Practice Address - Street 2:SUITE 404
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-5071
Practice Address - Country:US
Practice Address - Phone:603-228-1763
Practice Address - Fax:603-228-7088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH41110232Medicaid
NH41110232Medicaid