Provider Demographics
NPI:1467484386
Name:GLADSTONE, ALAN R (MD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:R
Last Name:GLADSTONE
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:PO BOX 655
Mailing Address - Street 2:
Mailing Address - City:EXETER
Mailing Address - State:NH
Mailing Address - Zip Code:03833-0655
Mailing Address - Country:US
Mailing Address - Phone:603-773-9992
Mailing Address - Fax:603-778-6393
Practice Address - Street 1:3 ALUMNI DR
Practice Address - Street 2:STE 101
Practice Address - City:EXETER
Practice Address - State:NH
Practice Address - Zip Code:03833-2122
Practice Address - Country:US
Practice Address - Phone:603-773-9992
Practice Address - Fax:603-778-6393
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH5916207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH82060291Medicaid
NHDD3385Medicare UPIN
NHNH029103Medicare PIN
NHNH0291Medicare ID - Type Unspecified
NH82060291Medicaid