Provider Demographics
NPI:1962662809
Name:GENDRON, VALERIE E (MD)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:E
Last Name:GENDRON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:590 COURT ST
Mailing Address - Street 2:
Mailing Address - City:KEENE
Mailing Address - State:NH
Mailing Address - Zip Code:03431-1719
Mailing Address - Country:US
Mailing Address - Phone:603-354-5400
Mailing Address - Fax:603-354-6540
Practice Address - Street 1:590 COURT ST
Practice Address - Street 2:
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431-1719
Practice Address - Country:US
Practice Address - Phone:603-354-5400
Practice Address - Fax:603-354-6540
Is Sole Proprietor?:No
Enumeration Date:2008-06-13
Last Update Date:2018-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH161082084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3087922Medicaid
NH003397001Medicare PIN