Provider Demographics
NPI:1811984040
Name:CLAREMONT PEDIATRIC SPECIALISTS
Entity type:Organization
Organization Name:CLAREMONT PEDIATRIC SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:BLAIR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:603-542-9505
Mailing Address - Street 1:9 DUNNING ST
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:NH
Mailing Address - Zip Code:03743-2016
Mailing Address - Country:US
Mailing Address - Phone:603-542-9505
Mailing Address - Fax:603-542-0969
Practice Address - Street 1:9 DUNNING ST
Practice Address - Street 2:
Practice Address - City:CLAREMONT
Practice Address - State:NH
Practice Address - Zip Code:03743-2016
Practice Address - Country:US
Practice Address - Phone:603-542-9505
Practice Address - Fax:603-542-0969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH6556208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH81373216Medicaid
3650653001OtherCIGNA
VT1000392Medicaid