Provider Demographics
NPI:1568704567
Name:MY FRIEND'S GYNECOLOGIST LLC
Entity Type:Organization
Organization Name:MY FRIEND'S GYNECOLOGIST LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:VANDERLINDE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:603-516-0000
Mailing Address - Street 1:839 CENTRAL AVE
Mailing Address - Street 2:SUITE ONE
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-2506
Mailing Address - Country:US
Mailing Address - Phone:603-516-0000
Mailing Address - Fax:603-516-5001
Practice Address - Street 1:839 CENTRAL AVE
Practice Address - Street 2:SUITE ONE
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-2506
Practice Address - Country:US
Practice Address - Phone:603-516-0000
Practice Address - Fax:603-516-5001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-18
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH10011261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHMM9346Medicare PIN