Provider Demographics
NPI:1265704308
Name:ANCIENT TRADITIONS NATURAL MEDICINE, LLC
Entity type:Organization
Organization Name:ANCIENT TRADITIONS NATURAL MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:P
Authorized Official - Last Name:LAMBERT
Authorized Official - Suffix:
Authorized Official - Credentials:ND, LAC
Authorized Official - Phone:603-431-0128
Mailing Address - Street 1:249 ISLINGTON ST
Mailing Address - Street 2:UNIT #10
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-4266
Mailing Address - Country:US
Mailing Address - Phone:603-431-0128
Mailing Address - Fax:603-590-2754
Practice Address - Street 1:249 ISLINGTON ST
Practice Address - Street 2:UNIT #10
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-4266
Practice Address - Country:US
Practice Address - Phone:603-431-0128
Practice Address - Fax:603-590-2754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-06
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHACP173171100000X
NH83175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty