Healthcare Provider Details

I. General information

NPI: 1457359556
Provider Name (Legal Business Name): BEDFORD COMMONS OB GYN PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 10/20/2022
Certification Date: 10/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 RIVERWAY PL
BEDFORD NH
03110-6763
US

IV. Provider business mailing address

201 RIVERWAY PL
BEDFORD NH
03110-6763
US

V. Phone/Fax

Practice location:
  • Phone: 603-668-8400
  • Fax: 603-629-9346
Mailing address:
  • Phone: 603-668-8400
  • Fax: 603-629-9346

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number StateNH

VIII. Authorized Official

Name: DR. MARC F LECLAIR
Title or Position: PRESIDENT
Credential: M.D.
Phone: 605-668-8400