Provider Demographics
NPI:1265413942
Name:LAFORTUNE-GREENBERG, TESSA J (MD)
Entity type:Individual
Prefix:
First Name:TESSA
Middle Name:J
Last Name:LAFORTUNE-GREENBERG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TESSA
Other - Middle Name:JL
Other - Last Name:GREENBERG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:253 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-7560
Mailing Address - Country:US
Mailing Address - Phone:603-226-2200
Mailing Address - Fax:
Practice Address - Street 1:253 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-7560
Practice Address - Country:US
Practice Address - Phone:603-226-6100
Practice Address - Fax:603-229-5314
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH12798208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30205288Medicaid
NHRE834901Medicare PIN
I35395Medicare UPIN