MEDICARE: ELLIOT PHYSICIANS NETWORK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	CG2227	OTHER	NH	RR MEDICARE GROUP #

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205821295
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELLIOT PHYSICIANS NETWORK

Provider Business Mailing Address
First Line	:	275 MAMMOTH RD STE 4
Second Line	:	DERRYFIELD MEDICAL GROUP
City	:	MANCHESTER
State	:	NH
Zip	:	03109-4133
Country	:	US
Telephone Number	:	603-624-4380
Fax Number	:	603-624-4805

Provider Business Practice Location Address
First Line	:	275 MAMMOTH RD STE 4
Second Line	:	DERRYFIELD MEDICAL GROUP
City	:	MANCHESTER
State	:	NH
Zip	:	03109-4133
Country	:	US
Telephone Number	:	603-624-4380
Fax Number	:	603-624-4805

Authorized Official
Title or Position	:	DIRECTOR OF OPERATIONS & FINANCE
Name	:	RICHARD P. HERMAN
Credential	:
Telephone Number	:	603-663-5766

Provider Enumeration Date	:	09/15/2005
Last Update Date	:	06/20/2008

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Practice Location Address:

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1114913142 — STEVEN B SCHWARTZ MD
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1669462354 — ROGER S. FRIEDEN MD
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1508856956 — SANDRA C. TRUEBE MD
Practice Location Address:

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1912997396 — ELLIOT PHYSICIANS NETWORK
Practice Location Address:

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1215927637 — LOUIS J. NACKMAN MD
Practice Location Address:

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Directions to “ELLIOT PHYSICIANS NETWORK ” Practice Location

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