Provider Demographics
NPI:1376726224
Name:CHRISTOPHER BUSH DPM, PLLC
Entity Type:Organization
Organization Name:CHRISTOPHER BUSH DPM, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:BUSH
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:603-929-9119
Mailing Address - Street 1:64 LAFAYETTE RD
Mailing Address - Street 2:UNIT 11
Mailing Address - City:NORTH HAMPTON
Mailing Address - State:NH
Mailing Address - Zip Code:03862-2456
Mailing Address - Country:US
Mailing Address - Phone:603-929-9119
Mailing Address - Fax:603-379-2947
Practice Address - Street 1:64 LAFAYETTE RD
Practice Address - Street 2:UNIT 11
Practice Address - City:NORTH HAMPTON
Practice Address - State:NH
Practice Address - Zip Code:03862-2456
Practice Address - Country:US
Practice Address - Phone:603-929-9119
Practice Address - Fax:603-379-2947
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-14
Last Update Date:2013-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0295213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30363251Medicaid
NH0007977Medicare PIN