Provider Demographics
NPI:1508091125
Name:BASSETT, ELLEN ADAMS (MD)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:ADAMS
Last Name:BASSETT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MEDICAL CENTER DR
Mailing Address - Street 2:DH - PALLIATIVE MEDICINE
Mailing Address - City:LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03756-1000
Mailing Address - Country:US
Mailing Address - Phone:603-650-5402
Mailing Address - Fax:603-650-8699
Practice Address - Street 1:1 MEDICAL CENTER DR
Practice Address - Street 2:DH - PALLIATIVE MEDICINE
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03756-1000
Practice Address - Country:US
Practice Address - Phone:603-650-5402
Practice Address - Fax:603-650-8699
Is Sole Proprietor?:No
Enumeration Date:2009-05-27
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH7109207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3077875Medicaid
NH3077875Medicaid
NHRE156801Medicare PIN