Provider Demographics
NPI:1609075274
Name:CORMIER, DAVID JOHN (DO, DPT)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:JOHN
Last Name:CORMIER
Suffix:
Gender:M
Credentials:DO, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 MARSH BROOK DR STE 205
Mailing Address - Street 2:
Mailing Address - City:SOMERSWORTH
Mailing Address - State:NH
Mailing Address - Zip Code:03878-6523
Mailing Address - Country:US
Mailing Address - Phone:603-742-2007
Mailing Address - Fax:603-749-4605
Practice Address - Street 1:7 MARSH BROOK DR STE 100
Practice Address - Street 2:
Practice Address - City:SOMERSWORTH
Practice Address - State:NH
Practice Address - Zip Code:03878-6523
Practice Address - Country:US
Practice Address - Phone:603-742-2007
Practice Address - Fax:603-749-4605
Is Sole Proprietor?:No
Enumeration Date:2007-07-13
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILP02592208100000X
MEPT3414225100000X
MA17919225100000X
VT0400003732225100000X
NH183562081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3110284Medicaid