Provider Demographics
NPI:1336129329
Name:CHRONISTER, RODNEY JAY (MD)
Entity Type:Individual
Prefix:
First Name:RODNEY
Middle Name:JAY
Last Name:CHRONISTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ROD
Other - Middle Name:J
Other - Last Name:CHRONISTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:101 WESTCHESTER WAY
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03104
Mailing Address - Country:US
Mailing Address - Phone:603-623-1934
Mailing Address - Fax:603-623-0065
Practice Address - Street 1:101 WESTCHESTER WAY
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03104-6497
Practice Address - Country:US
Practice Address - Phone:603-361-6669
Practice Address - Fax:603-623-0065
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH12597208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30205118Medicaid
NHRE8219Medicare ID - Type Unspecified
NH30205118Medicaid