Provider Demographics
NPI:1619038023
Name:GRANITE STATE EMERGENCY PHYSICIANS PC
Entity Type:Organization
Organization Name:GRANITE STATE EMERGENCY PHYSICIANS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAFFINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:603-663-6472
Mailing Address - Street 1:100 MCGREGOR ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03102-3730
Mailing Address - Country:US
Mailing Address - Phone:603-663-6472
Mailing Address - Fax:603-663-6645
Practice Address - Street 1:100 MCGREGOR ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03102-3730
Practice Address - Country:US
Practice Address - Phone:603-663-6472
Practice Address - Fax:603-663-6645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2008-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical ServicesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DF6851OtherRAILROAD MEDICARE
625983OtherTUFTS
7838900OtherAETNA
MA9755331Medicaid
38691OtherBMC HEALTHNET PLAN
NH30214885Medicaid
NH50Y004300NH01OtherANTHEM
612301300OtherOWCP
38691OtherBMC HEALTHNET PLAN