Provider Demographics
NPI:1831191659
Name:ELLIOT PHYSICIANS NETWORK
Entity type:Organization
Organization Name:ELLIOT PHYSICIANS NETWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS & FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:P
Authorized Official - Last Name:HERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-663-4904
Mailing Address - Street 1:1070 HOLT AVE
Mailing Address - Street 2:UNIT 1 SUITE 2200
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03109-5603
Mailing Address - Country:US
Mailing Address - Phone:603-663-4900
Mailing Address - Fax:603-663-4984
Practice Address - Street 1:1070 HOLT AVENUE
Practice Address - Street 2:UNIT 1 SUITE 2200
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03109
Practice Address - Country:US
Practice Address - Phone:603-663-4900
Practice Address - Fax:603-663-4984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH207R00000X, 207RG0300X, 208000000X, 207Q00000X
NH03977261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHCG2227OtherRR MEDICARE GROUP #
NHRE5600Medicare PIN