Provider Demographics
NPI:1619057080
Name:EXETER CARDIOVASCULAR ASSOCIATES
Entity Type:Organization
Organization Name:EXETER CARDIOVASCULAR ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:L
Authorized Official - Last Name:GILBERT
Authorized Official - Suffix:
Authorized Official - Credentials:CMPE
Authorized Official - Phone:603-773-9992
Mailing Address - Street 1:3 ALUMNI DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:EXETER
Mailing Address - State:NH
Mailing Address - Zip Code:03833-2119
Mailing Address - Country:US
Mailing Address - Phone:603-773-9992
Mailing Address - Fax:603-778-6393
Practice Address - Street 1:3 ALUMNI DR
Practice Address - Street 2:SUITE 101
Practice Address - City:EXETER
Practice Address - State:NH
Practice Address - Zip Code:03833-2119
Practice Address - Country:US
Practice Address - Phone:603-773-9992
Practice Address - Fax:603-778-6393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH50Y265400NH01OtherANTHEM
NH30213074Medicaid
NH50Y265400NH01OtherANTHEM