Provider Demographics
NPI:1780862912
Name:CATHOLIC MEDICAL CENTER PHYSICIAN PRACTICE ASSOCIATES
Entity Type:Organization
Organization Name:CATHOLIC MEDICAL CENTER PHYSICIAN PRACTICE ASSOCIATES
Other - Org Name:GRANITE STATE INTERNAL MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:ANDRE
Authorized Official - Middle Name:
Authorized Official - Last Name:THERRIEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-663-8779
Mailing Address - Street 1:53 GOFFSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03102-2737
Mailing Address - Country:US
Mailing Address - Phone:603-669-7162
Mailing Address - Fax:603-206-1378
Practice Address - Street 1:53 GOFFSTOWN RD
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03102-2737
Practice Address - Country:US
Practice Address - Phone:603-669-7162
Practice Address - Fax:603-206-1378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-11
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty