Healthcare Provider Details

I. General information

NPI: 1154310910
Provider Name (Legal Business Name): ELLIOT PHYSICIANS NETWORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2005
Last Update Date: 06/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 CONSTITUTION DR ELLIOT FAMILY MEDICINE AT BEDFORD VILLAGE
BEDFORD NH
03110-6042
US

IV. Provider business mailing address

15 CONSTITUTION DR ELLIOT FAMILY MEDICINE AT BEDFORD VILLAGE
BEDFORD NH
03110-6042
US

V. Phone/Fax

Practice location:
  • Phone: 603-472-7233
  • Fax: 603-472-9188
Mailing address:
  • Phone: 603-472-7233
  • Fax: 603-472-9188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: RICHARD P. HERMAN
Title or Position: DIRECTOR OF OPERATIONS & FINANCE
Credential:
Phone: 603-663-5766