Provider Demographics
NPI:1245205046
Name:LACONIA CARDIOLOGY
Entity Type:Organization
Organization Name:LACONIA CARDIOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER- 2009
Authorized Official - Prefix:
Authorized Official - First Name:MARY CLAIRE
Authorized Official - Middle Name:
Authorized Official - Last Name:PAICOPOLIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FACC
Authorized Official - Phone:603-528-8555
Mailing Address - Street 1:369 HOUNSELL AVENUE
Mailing Address - Street 2:
Mailing Address - City:GILFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03249
Mailing Address - Country:US
Mailing Address - Phone:603-528-8555
Mailing Address - Fax:603-528-7668
Practice Address - Street 1:369 HOUNSELL AVENUE
Practice Address - Street 2:SUITE #5
Practice Address - City:GILFORD
Practice Address - State:NH
Practice Address - Zip Code:03249
Practice Address - Country:US
Practice Address - Phone:603-528-8555
Practice Address - Fax:603-528-7668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-23
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30005918Medicaid
F48312Medicare UPIN
NHRE2762Medicare ID - Type Unspecified
NH30005918Medicaid