Provider Demographics
NPI:1558448019
Name:DOVER PEDIATRICS PLLC
Entity Type:Organization
Organization Name:DOVER PEDIATRICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:R
Authorized Official - Last Name:SOARES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:603-742-4048
Mailing Address - Street 1:17 OLD ROLLINSFORD RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-2833
Mailing Address - Country:US
Mailing Address - Phone:603-742-4048
Mailing Address - Fax:603-743-3345
Practice Address - Street 1:17 OLD ROLLINSFORD RD
Practice Address - Street 2:SUITE 5
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-2833
Practice Address - Country:US
Practice Address - Phone:603-742-4048
Practice Address - Fax:603-743-3345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH40217649Medicaid