Provider Demographics
NPI:1942214457
Name:GRANITE STATE GASTROINTESTINAL CONSULTANTS PLLC
Entity Type:Organization
Organization Name:GRANITE STATE GASTROINTESTINAL CONSULTANTS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KNUT
Authorized Official - Middle Name:
Authorized Official - Last Name:ROALSVIG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:603-432-8802
Mailing Address - Street 1:50 MICHELS WAY
Mailing Address - Street 2:
Mailing Address - City:LONDONDERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03053
Mailing Address - Country:US
Mailing Address - Phone:603-432-8802
Mailing Address - Fax:603-437-0118
Practice Address - Street 1:50 MICHELS WAY
Practice Address - Street 2:
Practice Address - City:LONDONDERRY
Practice Address - State:NH
Practice Address - Zip Code:03053
Practice Address - Country:US
Practice Address - Phone:603-432-8802
Practice Address - Fax:603-437-0118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30002464Medicaid
NH30002464Medicaid