Provider Demographics
NPI:1790760155
Name:ISLAMOVIC, ENEIDA (PA)
Entity Type:Individual
Prefix:
First Name:ENEIDA
Middle Name:
Last Name:ISLAMOVIC
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 ELLIOT WAY STE 102
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03103-3551
Mailing Address - Country:US
Mailing Address - Phone:603-626-5900
Mailing Address - Fax:603-625-2180
Practice Address - Street 1:4 ELLIOT WAY STE 102
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03103-3551
Practice Address - Country:US
Practice Address - Phone:603-626-5900
Practice Address - Fax:603-625-2180
Is Sole Proprietor?:No
Enumeration Date:2005-12-08
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0555P363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30333620Medicaid
NHAP2420Medicare ID - Type Unspecified
NHQ45411Medicare UPIN