Healthcare Provider Details

I. General information

NPI: 1063604809
Provider Name (Legal Business Name): AMHERST PEDIATRICS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2007
Last Update Date: 08/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 OLD NASHUA RD SUITE 14
AMHERST NH
03031-2829
US

IV. Provider business mailing address

31 OLD NASHUA RD SUITE 14
AMHERST NH
03031-2829
US

V. Phone/Fax

Practice location:
  • Phone: 603-673-7577
  • Fax: 603-673-8788
Mailing address:
  • Phone: 603-673-7577
  • Fax: 603-673-8788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number8281
License Number StateNH

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier30214649
Identifier TypeMEDICAID
Identifier StateNH
Identifier Issuer

VIII. Authorized Official

Name: DR. JAMES A CANFIELD
Title or Position: MEMBER
Credential: MD
Phone: 603-673-7577