Provider Demographics
NPI:1669659793
Name:COLLINS, JEREMY GIERE (MD)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:GIERE
Last Name:COLLINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 S. MAIN ST.
Mailing Address - Street 2:SUITE 2
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301
Mailing Address - Country:US
Mailing Address - Phone:603-622-8665
Mailing Address - Fax:833-413-4978
Practice Address - Street 1:46 S. MAIN ST.
Practice Address - Street 2:SUITE 2
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301
Practice Address - Country:US
Practice Address - Phone:603-622-8665
Practice Address - Fax:833-413-4978
Is Sole Proprietor?:No
Enumeration Date:2008-01-31
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH16634207QA0401X, 2081P2900X
MA2532332081P2900X
DEC1-00096792081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3097859Medicaid