Provider Demographics
NPI:1518928316
Name:GEMMETT, STEPHEN M (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:M
Last Name:GEMMETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:789 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-2526
Mailing Address - Country:US
Mailing Address - Phone:603-516-4265
Mailing Address - Fax:603-740-2713
Practice Address - Street 1:19 OLD ROLLINSFORD RD
Practice Address - Street 2:BUILDING B
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-2807
Practice Address - Country:US
Practice Address - Phone:603-516-4265
Practice Address - Fax:603-740-2173
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH12061208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1518928316Medicaid
NH3075234Medicaid
NHT400207710Medicare PIN
G61543Medicare UPIN