Provider Demographics
NPI:1538514435
Name:DICROCE, CHRISTOPHER B (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:B
Last Name:DICROCE
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 1:1 ELLIOT WAY
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03103-3599
Mailing Address - Country:US
Mailing Address - Phone:603-663-4919
Mailing Address - Fax:603-663-4949
Practice Address - Street 1:1 ELLIOT WAY
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03103-3599
Practice Address - Country:US
Practice Address - Phone:603-663-4919
Practice Address - Fax:603-663-4949
Is Sole Proprietor?:No
Enumeration Date:2016-04-28
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA277968207P00000X
NH20470207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110115441AMedicaid