Healthcare Provider Details

I. General information

NPI: 1013984244
Provider Name (Legal Business Name): JONATHAN BLAIR LAMPHIER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 12/24/2019
Certification Date: 12/24/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 DOCTORS CIR STE 5
SUPPLY NC
28462-6357
US

IV. Provider business mailing address

600 SAINT JOHNSBURY RD
LITTLETON NH
03561-3442
US

V. Phone/Fax

Practice location:
  • Phone: 910-754-5988
  • Fax: 910-754-5989
Mailing address:
  • Phone: 603-444-9541
  • Fax: 603-259-7561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number9347
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number2014-02003
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: