Provider Demographics
NPI:1205076148
Name:WOMEN'S DIAGNOSTIC ULTRASOUND SUITE
Entity type:Organization
Organization Name:WOMEN'S DIAGNOSTIC ULTRASOUND SUITE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:L
Authorized Official - Last Name:BORDEN-ELFNER
Authorized Official - Suffix:
Authorized Official - Credentials:RDMS
Authorized Official - Phone:603-767-9736
Mailing Address - Street 1:839 CENTRAL AVE
Mailing Address - Street 2:SUITE 8
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-2506
Mailing Address - Country:US
Mailing Address - Phone:603-767-9736
Mailing Address - Fax:
Practice Address - Street 1:839 CENTRAL AVE
Practice Address - Street 2:SUITE 8
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-2506
Practice Address - Country:US
Practice Address - Phone:603-767-9736
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-05
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH963222471S1302X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonographyGroup - Single Specialty