Provider Demographics
NPI:1659481950
Name:THE DOCTOR'S OFFICE AT SALMON STREET PC
Entity Type:Organization
Organization Name:THE DOCTOR'S OFFICE AT SALMON STREET PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SWIADAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-625-1724
Mailing Address - Street 1:765 S MAIN ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03102-5141
Mailing Address - Country:US
Mailing Address - Phone:603-625-1724
Mailing Address - Fax:603-625-1230
Practice Address - Street 1:765 S MAIN ST
Practice Address - Street 2:SUITE 103
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03102-5141
Practice Address - Country:US
Practice Address - Phone:603-625-1724
Practice Address - Fax:603-625-1230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3074417Medicaid