Provider Demographics
NPI:1629132139
Name:CONCORD NEUROLOGICAL ASSOCIATES
Entity Type:Organization
Organization Name:CONCORD NEUROLOGICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:LOMBARDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:603-224-6691
Mailing Address - Street 1:248 PLEASANT ST
Mailing Address - Street 2:SUITE G200, PILLSBURY BUILDING
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-2588
Mailing Address - Country:US
Mailing Address - Phone:603-224-6691
Mailing Address - Fax:603-228-7087
Practice Address - Street 1:248 PLEASANT ST
Practice Address - Street 2:SUITE G200, PILLSBURY BUILDING
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-2588
Practice Address - Country:US
Practice Address - Phone:603-224-6691
Practice Address - Fax:603-228-7087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30001584Medicaid
NHNH9106Medicare ID - Type Unspecified