Provider Demographics
NPI:1548592223
Name:ELLIOT PHYSICIANS NETWORK
Entity Type:Organization
Organization Name:ELLIOT PHYSICIANS NETWORK
Other - Org Name:ELLIOT PEDIATRICS AT LONDONDERRY
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS & FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:P
Authorized Official - Last Name:HERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-663-4904
Mailing Address - Street 1:18 ORCHARD VIEW DR
Mailing Address - Street 2:ELLIOT PEDIATRICS AT LONDONDERRY
Mailing Address - City:LONDONDERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03053-6605
Mailing Address - Country:US
Mailing Address - Phone:603-552-1350
Mailing Address - Fax:603-552-1359
Practice Address - Street 1:18 ORCHARD VIEW DR
Practice Address - Street 2:ELLIOT PEDIATRICS AT LONDONDERRY
Practice Address - City:LONDONDERRY
Practice Address - State:NH
Practice Address - Zip Code:03053-6605
Practice Address - Country:US
Practice Address - Phone:603-552-1350
Practice Address - Fax:603-552-1359
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELLIOT PHYSICIANS NETWORK
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-02-05
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHRE5600Medicare PIN