Provider Demographics
NPI:1255379194
Name:DOVER INTERNAL AND GERIATRIC MEDICINE, PLLC
Entity type:Organization
Organization Name:DOVER INTERNAL AND GERIATRIC MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:PAGNOTTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-742-3666
Mailing Address - Street 1:801 CENTRAL AVE
Mailing Address - Street 2:STE 2
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-2529
Mailing Address - Country:US
Mailing Address - Phone:603-742-3666
Mailing Address - Fax:603-742-6119
Practice Address - Street 1:801 CENTRAL AVE
Practice Address - Street 2:STE 2
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-2529
Practice Address - Country:US
Practice Address - Phone:603-742-3666
Practice Address - Fax:603-742-6119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH5901207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHNH3538Medicare ID - Type Unspecified