Provider Demographics
NPI:1346239878
Name:PARKLAND PHYSICIAN SERVICES INC
Entity Type:Organization
Organization Name:PARKLAND PHYSICIAN SERVICES INC
Other - Org Name:PARKLAND FAMILY PRACTICE OF LONDONDERRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:KEN
Authorized Official - Middle Name:
Authorized Official - Last Name:WASHINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-650-2907
Mailing Address - Street 1:41 BUTTRICK RD
Mailing Address - Street 2:
Mailing Address - City:LONDONDERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03053-3367
Mailing Address - Country:US
Mailing Address - Phone:603-890-5934
Mailing Address - Fax:603-432-8801
Practice Address - Street 1:41 BUTTRICK RD
Practice Address - Street 2:
Practice Address - City:LONDONDERRY
Practice Address - State:NH
Practice Address - Zip Code:03053-3367
Practice Address - Country:US
Practice Address - Phone:603-890-5934
Practice Address - Fax:603-432-8801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-18
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30214303Medicaid
NHRE3445Medicaid
MARE3445Medicare PIN