Provider Demographics
NPI:1699178459
Name:CHRISTOPHER BUSH DPM, PLLC
Entity Type:Organization
Organization Name:CHRISTOPHER BUSH DPM, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:BUSH
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:603-929-9119
Mailing Address - Street 1:130 CENTRAL AVE
Mailing Address - Street 2:SUITE LL7
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-4042
Mailing Address - Country:US
Mailing Address - Phone:603-929-9119
Mailing Address - Fax:603-379-2047
Practice Address - Street 1:130 CENTRAL AVE
Practice Address - Street 2:SUITE LL7
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-4042
Practice Address - Country:US
Practice Address - Phone:603-929-9119
Practice Address - Fax:603-379-2047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-07
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0295213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3074950Medicaid
NHU81488Medicare UPIN
NH3074950Medicaid