Provider Demographics
NPI:1366467474
Name:HENRIQUES, HORACE FULLER III (MD)
Entity Type:Individual
Prefix:DR
First Name:HORACE
Middle Name:FULLER
Last Name:HENRIQUES
Suffix:III
Gender:M
Credentials:MD
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Mailing Address - Street 1:74 PLEASANT ST
Mailing Address - Street 2:STE 204
Mailing Address - City:NEW LONDON
Mailing Address - State:NH
Mailing Address - Zip Code:03257-5881
Mailing Address - Country:US
Mailing Address - Phone:603-650-8113
Mailing Address - Fax:603-650-8030
Practice Address - Street 1:1 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03756-1000
Practice Address - Country:US
Practice Address - Phone:603-650-8113
Practice Address - Fax:603-650-8030
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2017-01-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NH8675208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH80002054Medicaid
VT0002054Medicaid
NHRE205402Medicare PIN
E23086Medicare UPIN