Provider Demographics
NPI:1417251059
Name:CONCETTA R OTERI-AHMADPOUR
Entity Type:Organization
Organization Name:CONCETTA R OTERI-AHMADPOUR
Other - Org Name:WHOLISTIC FAMILY WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CONCETTA
Authorized Official - Middle Name:R
Authorized Official - Last Name:OTERI-AHMADPOUR
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:603-673-1181
Mailing Address - Street 1:11 STONE CT
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03055-3575
Mailing Address - Country:US
Mailing Address - Phone:603-673-1181
Mailing Address - Fax:
Practice Address - Street 1:31 OLD NASHUA RD
Practice Address - Street 2:UNIT 14
Practice Address - City:AMHERST
Practice Address - State:NH
Practice Address - Zip Code:03031-2829
Practice Address - Country:US
Practice Address - Phone:603-673-1181
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-22
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH122549207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty