Healthcare Provider Details

I. General information

NPI: 1487986840
Provider Name (Legal Business Name): NANCY J CHAREST M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2010
Last Update Date: 09/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 WASHINGTON PL
BEDFORD NH
03110-6736
US

IV. Provider business mailing address

5 WASHINGTON PL
BEDFORD NH
03110-6736
US

V. Phone/Fax

Practice location:
  • Phone: 603-695-2500
  • Fax:
Mailing address:
  • Phone: 603-695-2500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number023678
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number14863
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: