Provider Demographics
NPI:1790011633
Name:ELLIOT PHYSICIAN NETWORK
Entity Type:Organization
Organization Name:ELLIOT PHYSICIAN NETWORK
Other - Org Name:ELLIOT PEAK INTERNAL MEDICINE AT WINDHAM
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS & FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:P
Authorized Official - Last Name:HERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-663-4904
Mailing Address - Street 1:127 ROCKINGHAM RD STE 103
Mailing Address - Street 2:ELLIOT PEAK INTERNAL MEDICINE AT WINDHAM
Mailing Address - City:WINDHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03087-1360
Mailing Address - Country:US
Mailing Address - Phone:603-890-0266
Mailing Address - Fax:603-890-0267
Practice Address - Street 1:127 ROCKINGHAM RD STE 103
Practice Address - Street 2:ELLIOT PEAK INTERNAL MEDICINE AT WINDHAM
Practice Address - City:WINDHAM
Practice Address - State:NH
Practice Address - Zip Code:03087-1360
Practice Address - Country:US
Practice Address - Phone:603-890-0266
Practice Address - Fax:603-890-0267
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELLIOT PHYSICIAN NETWORK
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-10-28
Last Update Date:2009-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHRE5600Medicare PIN