Provider Demographics
NPI:1881401552
Name:CONVENIENTMD LLC
Entity type:Organization
Organization Name:CONVENIENTMD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP, REVENUE CYCLE MANAGEMENT
Authorized Official - Prefix:
Authorized Official - First Name:JAROD
Authorized Official - Middle Name:
Authorized Official - Last Name:BOISSONNEAULT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-410-6700
Mailing Address - Street 1:360 US HIGHWAY 1 BYP UNIT 102
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-7105
Mailing Address - Country:US
Mailing Address - Phone:603-410-6700
Mailing Address - Fax:603-319-8308
Practice Address - Street 1:687 BROADWAY
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:03833
Practice Address - Country:US
Practice Address - Phone:207-744-8424
Practice Address - Fax:207-744-8425
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CONVENIENTMD LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-12-16
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty