Provider Demographics
NPI:1912958703
Name:DIVENUTI, GINA M (MD)
Entity Type:Individual
Prefix:DR
First Name:GINA
Middle Name:M
Last Name:DIVENUTI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:200 TECHNOLOGY DR
Mailing Address - Street 2:
Mailing Address - City:HOOKSETT
Mailing Address - State:NH
Mailing Address - Zip Code:03106-2504
Mailing Address - Country:US
Mailing Address - Phone:603-622-6484
Mailing Address - Fax:603-622-7438
Practice Address - Street 1:250 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-7559
Practice Address - Country:US
Practice Address - Phone:603-622-6484
Practice Address - Fax:603-622-7438
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NH11904207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30203690Medicaid
NHH87821Medicare UPIN
NHRE7262Medicare PIN
NHP00066907Medicare PIN