Provider Demographics
NPI:1720043516
Name:CARPENTIER, DOMINIQUE A (MD)
Entity Type:Individual
Prefix:
First Name:DOMINIQUE
Middle Name:A
Last Name:CARPENTIER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 HOLLAND WAY FL 1
Mailing Address - Street 2:
Mailing Address - City:EXETER
Mailing Address - State:NH
Mailing Address - Zip Code:03833-2997
Mailing Address - Country:US
Mailing Address - Phone:603-868-5832
Mailing Address - Fax:603-868-5408
Practice Address - Street 1:44 NEWMARKET RD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NH
Practice Address - Zip Code:03824-2826
Practice Address - Country:US
Practice Address - Phone:603-868-5832
Practice Address - Fax:603-868-5408
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH16505207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3098659Medicaid
MEE400159161Medicare PIN
ME030258OtherANTHEM
MEMM6919Medicare ID - Type Unspecified
ME1040994OtherAETNA
ME6395708002OtherCIGNA
G53424Medicare UPIN
ME280120099Medicaid