Healthcare Provider Details

I. General information

NPI: 1942209945
Provider Name (Legal Business Name): PULMONARY MEDICINE ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

706 RIVERWAY PL
BEDFORD NH
03110-6768
US

IV. Provider business mailing address

706 RIVERWAY PL
BEDFORD NH
03110-6768
US

V. Phone/Fax

Practice location:
  • Phone: 603-623-3516
  • Fax: 603-623-3580
Mailing address:
  • Phone: 603-623-3516
  • Fax: 603-623-3580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number StateNH

VIII. Authorized Official

Name: KAREN L STANTON
Title or Position: OFFICE MANAGER
Credential:
Phone: 603-623-3516