Provider Demographics
NPI:1598756488
Name:ELLIOT PHYSICIANS NETWORK
Entity Type:Organization
Organization Name:ELLIOT PHYSICIANS NETWORK
Other - Org Name:ELLIOT PEDIATRICS AND PRIMARY CARE AT RAYMOND
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 1:15 FREETOWN RD
Mailing Address - Street 2:ELLIOT PEDIATRICS AND PRIMARY CARE AT RAYMOND
Mailing Address - City:RAYMOND
Mailing Address - State:NH
Mailing Address - Zip Code:03077-2358
Mailing Address - Country:US
Mailing Address - Phone:603-895-8000
Mailing Address - Fax:603-895-8099
Practice Address - Street 1:15 FREETOWN RD
Practice Address - Street 2:ELLIOT PEDIATRICS AND PRIMARY CARE AT RAYMOND
Practice Address - City:RAYMOND
Practice Address - State:NH
Practice Address - Zip Code:03077-2358
Practice Address - Country:US
Practice Address - Phone:603-895-8000
Practice Address - Fax:603-895-8099
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELLIOT PHYSICIANS NETWORK
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-10-31
Last Update Date:2009-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30211870Medicaid
NHCG2227OtherRR MEDICARE GROUP #
NHRE5600Medicare PIN