Provider Demographics
NPI:1649253261
Name:BOTSFORD, DANIEL R JR (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:R
Last Name:BOTSFORD
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:185 QUEEN CITY AVE
Mailing Address - Street 2:ELLIOT NEUROLOGY ASSOCIATES
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03101-7100
Mailing Address - Country:US
Mailing Address - Phone:603-669-0859
Mailing Address - Fax:603-644-3391
Practice Address - Street 1:185 QUEEN CITY AVE
Practice Address - Street 2:ELLIOT NEUROLOGY ASSOCIATES
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03101-7100
Practice Address - Country:US
Practice Address - Phone:603-669-0859
Practice Address - Fax:603-644-3391
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NH61242084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH81130402Medicaid
C66352Medicare UPIN
NHC66352Medicare ID - Type Unspecified