Provider Demographics
NPI:1023431897
Name:GEROMED PC
Entity type:Organization
Organization Name:GEROMED PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE SECRETARY
Authorized Official - Prefix:MS
Authorized Official - First Name:PAULINE
Authorized Official - Middle Name:M
Authorized Official - Last Name:MERIDIEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-746-4164
Mailing Address - Street 1:334 COLLEGE HILL RD
Mailing Address - Street 2:
Mailing Address - City:HOPKINTON
Mailing Address - State:NH
Mailing Address - Zip Code:03229-3404
Mailing Address - Country:US
Mailing Address - Phone:603-746-4164
Mailing Address - Fax:603-746-3522
Practice Address - Street 1:334 COLLEGE HILL RD
Practice Address - Street 2:
Practice Address - City:HOPKINTON
Practice Address - State:NH
Practice Address - Zip Code:03229-3404
Practice Address - Country:US
Practice Address - Phone:603-746-4164
Practice Address - Fax:603-746-3522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-29
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH69752084P2900X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RE1737Medicare UPIN