Healthcare Provider Details

I. General information

NPI: 1972559904
Provider Name (Legal Business Name): CATHOLIC MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 06/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 WASHINGTON PL
BEDFORD NH
03110-6706
US

IV. Provider business mailing address

20 WASHINGTON PLACE
BEDFORD NH
03110
US

V. Phone/Fax

Practice location:
  • Phone: 603-663-8060
  • Fax:
Mailing address:
  • Phone: 603-663-7852
  • Fax: 603-663-7895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: BONNIE MCKELLAR
Title or Position: ADMINISTRATOR
Credential:
Phone: 603-663-5248