Provider Demographics
NPI:1467437822
Name:COOMBS, DENNIS W (MD)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:W
Last Name:COOMBS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:397 HANOVER CENTER RD
Mailing Address - Street 2:
Mailing Address - City:ETNA
Mailing Address - State:NH
Mailing Address - Zip Code:03750-4213
Mailing Address - Country:US
Mailing Address - Phone:603-443-9508
Mailing Address - Fax:603-443-9549
Practice Address - Street 1:125 MASCOMA ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03766-2647
Practice Address - Country:US
Practice Address - Phone:603-443-9508
Practice Address - Fax:603-443-9549
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-08
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH5506174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30010734Medicaid
NHRE0467Medicare ID - Type Unspecified
NH30010734Medicaid