Provider Demographics
NPI:1710133087
Name:AESTHETIC MEDICINE OF NH
Entity Type:Organization
Organization Name:AESTHETIC MEDICINE OF NH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:VAN LOAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:603-224-0808
Mailing Address - Street 1:194 PLEASANT ST
Mailing Address - Street 2:SUITE 12
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-2952
Mailing Address - Country:US
Mailing Address - Phone:603-224-0808
Mailing Address - Fax:603-224-0853
Practice Address - Street 1:194 PLEASANT ST
Practice Address - Street 2:SUITE 12
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-2952
Practice Address - Country:US
Practice Address - Phone:603-224-0808
Practice Address - Fax:603-224-0853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-18
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH6630207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty