Healthcare Provider Details

I. General information

NPI: 1114734035
Provider Name (Legal Business Name): BEDFORD GASTROENTEROLOGY,PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2024
Last Update Date: 02/26/2025
Certification Date: 02/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 WASHINGTON PL STE 201
BEDFORD NH
03110-6750
US

IV. Provider business mailing address

9 WASHINGTON PL STE 201
BEDFORD NH
03110-6750
US

V. Phone/Fax

Practice location:
  • Phone: 603-367-3064
  • Fax: 603-367-3065
Mailing address:
  • Phone: 603-367-3064
  • Fax: 603-367-3065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CHRISTOPHER NICHOLAS DAINIAK
Title or Position: OWNER
Credential: MD
Phone: 603-367-3064