Provider Demographics
NPI:1235797564
Name:ELLACOYA MEDICAL SERVICES PLLC
Entity Type:Organization
Organization Name:ELLACOYA MEDICAL SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:BASSEM
Authorized Official - Middle Name:
Authorized Official - Last Name:AZKUL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:603-366-6107
Mailing Address - Street 1:17 TARBELL RD
Mailing Address - Street 2:
Mailing Address - City:WINDHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03087-1170
Mailing Address - Country:US
Mailing Address - Phone:603-366-6107
Mailing Address - Fax:
Practice Address - Street 1:254 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-2551
Practice Address - Country:US
Practice Address - Phone:603-266-9800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-01
Last Update Date:2019-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty