Provider Demographics
NPI:1578763637
Name:ELLIOT PHYSICIANS NETWORK
Entity Type:Organization
Organization Name:ELLIOT PHYSICIANS NETWORK
Other - Org Name:ELLIOT HAMPSHIRE PEDIATRICS
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:
Authorized Official - Last Name:HERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-663-4904
Mailing Address - Street 1:113 MAMMOTH RD
Mailing Address - Street 2:ELLIOT HAMPSHIRE PEDIATRICS
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03109-4337
Mailing Address - Country:US
Mailing Address - Phone:603-623-2229
Mailing Address - Fax:603-626-8016
Practice Address - Street 1:113 MAMMOTH RD
Practice Address - Street 2:ELLIOT HAMPSHIRE PEDIATRICS
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03109-4337
Practice Address - Country:US
Practice Address - Phone:603-623-2229
Practice Address - Fax:603-626-8016
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELLIOT PHYSICIANS NETWORK
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-18
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHCG2227OtherRR MEDICARE
NH30215237Medicaid
NHCG2227OtherRR MEDICARE