Provider Demographics
NPI:1326408709
Name:EPHREM MEDICAL SERVICES, LLC
Entity Type:Organization
Organization Name:EPHREM MEDICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VERCIN
Authorized Official - Middle Name:S
Authorized Official - Last Name:EPHREM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:603-455-8175
Mailing Address - Street 1:304 TURNER WAY
Mailing Address - Street 2:
Mailing Address - City:LACONIA
Mailing Address - State:NH
Mailing Address - Zip Code:03246-1691
Mailing Address - Country:US
Mailing Address - Phone:603-455-8175
Mailing Address - Fax:
Practice Address - Street 1:304 TURNER WAY
Practice Address - Street 2:
Practice Address - City:LACONIA
Practice Address - State:NH
Practice Address - Zip Code:03246-1691
Practice Address - Country:US
Practice Address - Phone:603-455-8175
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-29
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH13040207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty