Provider Demographics
NPI:1326400656
Name:CENTER FOR KIDNEY AND METABOLIC DISORDERS PLLC
Entity Type:Organization
Organization Name:CENTER FOR KIDNEY AND METABOLIC DISORDERS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANA
Authorized Official - Middle Name:R
Authorized Official - Last Name:STANKOVIC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:603-890-2771
Mailing Address - Street 1:31 STILES RD STE 2400
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:NH
Mailing Address - Zip Code:03079-3037
Mailing Address - Country:US
Mailing Address - Phone:603-890-2771
Mailing Address - Fax:603-890-2886
Practice Address - Street 1:31 STILES RD STE 2400
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:NH
Practice Address - Zip Code:03079
Practice Address - Country:US
Practice Address - Phone:603-890-2771
Practice Address - Fax:603-890-2886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-25
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH13080207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2091691Medicaid
NH207RN0300XOtherNEPHROLOGY
NH30206300Medicaid
MA207RN0300XOtherNEPHROLOGY
NH207RH0005XOtherHYPERTENSION SPECIALIST