Provider Demographics
NPI:1306396452
Name:INSIGHT MEDICAL GROUP LLC
Entity Type:Organization
Organization Name:INSIGHT MEDICAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER/PRACTITIONER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:DILLON
Authorized Official - Suffix:JR
Authorized Official - Credentials:NP
Authorized Official - Phone:978-267-1193
Mailing Address - Street 1:861 LAFAYETTE RD UNIT 6
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:NH
Mailing Address - Zip Code:03842-1232
Mailing Address - Country:US
Mailing Address - Phone:978-267-1193
Mailing Address - Fax:888-979-8717
Practice Address - Street 1:861 LAFAYETTE RD UNIT 6
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:NH
Practice Address - Zip Code:03842-1232
Practice Address - Country:US
Practice Address - Phone:978-267-1193
Practice Address - Fax:888-979-8717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-12
Last Update Date:2020-04-02
Deactivation Date:2018-09-22
Deactivation Code:
Reactivation Date:2020-01-24
Provider Licenses
StateLicense IDTaxonomies
NH046771-23261QM0850X, 261QP2300X, 261QR0800X, 261QR0800X
NH15053261QR0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QR0800XAmbulatory Health Care FacilitiesClinic/CenterRecovery Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30344609Medicaid
NHQ72374Medicare UPIN
NH30344609Medicaid