Provider Demographics
NPI:1831246693
Name:DUMORE, SUSAN
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:DUMORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 RYE ST
Mailing Address - Street 2:STE 125
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-6829
Mailing Address - Country:US
Mailing Address - Phone:603-610-2200
Mailing Address - Fax:
Practice Address - Street 1:15 RYE ST
Practice Address - Street 2:STE 125
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-6829
Practice Address - Country:US
Practice Address - Phone:603-610-2200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0849225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH542065286OtherTAX IDENTIFICATION NUMBER
NH0808117Y0NH01OtherANTHEM PROVIDER NUMBER
NH626470OtherHPHC PROVIDER NUMBER
NHRE6957Medicare PIN