Provider Demographics
NPI:1962488171
Name:MANCHESTER INTERNAL MEDICINE ASSOCIATES, P. C.
Entity Type:Organization
Organization Name:MANCHESTER INTERNAL MEDICINE ASSOCIATES, P. C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PEGGY
Authorized Official - Middle Name:S
Authorized Official - Last Name:KNIGHTLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-622-4200
Mailing Address - Street 1:1650 ELM ST
Mailing Address - Street 2:SUITE 302
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03101-1217
Mailing Address - Country:US
Mailing Address - Phone:603-622-4200
Mailing Address - Fax:
Practice Address - Street 1:1650 ELM ST
Practice Address - Street 2:SUITE 302
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03101-1217
Practice Address - Country:US
Practice Address - Phone:603-622-4200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH80008153Medicaid
NHNH8153Medicare ID - Type Unspecified