Provider Demographics
NPI:1396822300
Name:EXETER HAMPTON DIAGNOSTIC, INC
Entity Type:Organization
Organization Name:EXETER HAMPTON DIAGNOSTIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:WINDT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:603-964-3392
Mailing Address - Street 1:65 LAFAYETTE RD
Mailing Address - Street 2:
Mailing Address - City:NORTH HAMPTON
Mailing Address - State:NH
Mailing Address - Zip Code:03862-2480
Mailing Address - Country:US
Mailing Address - Phone:603-964-3392
Mailing Address - Fax:603-964-3396
Practice Address - Street 1:65 LAFAYETTE RD
Practice Address - Street 2:
Practice Address - City:NORTH HAMPTON
Practice Address - State:NH
Practice Address - Zip Code:03862-2480
Practice Address - Country:US
Practice Address - Phone:603-964-3392
Practice Address - Fax:603-964-3396
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2015-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH02815293D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH80008697Medicaid
NH7608697Y0NH01OtherANTHEM
NH7608697Y0NH01OtherANTHEM