Provider Demographics
NPI:1740379940
Name:GREATER HAMPSTEAD FAMILY MEDICINE, INC.
Entity Type:Organization
Organization Name:GREATER HAMPSTEAD FAMILY MEDICINE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:VAILAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-232-4513
Mailing Address - Street 1:55 BRIDGE STREET
Mailing Address - Street 2:
Mailing Address - City:MACHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03101
Mailing Address - Country:US
Mailing Address - Phone:603-232-4513
Mailing Address - Fax:603-232-4563
Practice Address - Street 1:207 STAGE RD
Practice Address - Street 2:
Practice Address - City:HAMPSTEAD
Practice Address - State:NH
Practice Address - Zip Code:03841-2224
Practice Address - Country:US
Practice Address - Phone:603-329-5222
Practice Address - Fax:603-329-8016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2023-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH8735207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1558350223OtherDR CAMMILLERI'S NPI
F19910Medicare UPIN
300009282Medicare ID - Type UnspecifiedGROUP NUMBER
RE6817Medicare ID - Type UnspecifiedGROUP NUMBER