Provider Demographics
NPI:1225132962
Name:FIESEHER, JAMES G (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:G
Last Name:FIESEHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 HITCHCOCK WAY
Mailing Address - Street 2:DARTMOUTH HITCHCOCK - FAMILY MEDICINE
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03104
Mailing Address - Country:US
Mailing Address - Phone:603-695-2664
Mailing Address - Fax:
Practice Address - Street 1:100 HITCHCOCK WAY
Practice Address - Street 2:DARTMOUTH HITCHCOCK - FAMILY MEDICINE
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03104
Practice Address - Country:US
Practice Address - Phone:603-695-2664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH8284207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30210770Medicaid
NH80001275Medicaid
RE1275Medicare ID - Type Unspecified
NH80001275Medicaid
NH30210770Medicaid