Provider Demographics
NPI:1336161652
Name:DELGIUDICE, STEPHEN MARK (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:MARK
Last Name:DELGIUDICE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:603-226-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH7518207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30002489Medicaid
NH30002489Medicaid
NHSX0206Medicare PIN