Healthcare Provider Details

I. General information

NPI: 1851396006
Provider Name (Legal Business Name): DR SULS FAMILY & SPORTS MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2005
Last Update Date: 06/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 WASHINGTON PL STE 3
BEDFORD NH
03110-6743
US

IV. Provider business mailing address

20 WASHINGTON PL STE 3
BEDFORD NH
03110-6743
US

V. Phone/Fax

Practice location:
  • Phone: 603-622-2112
  • Fax: 603-624-1570
Mailing address:
  • Phone: 603-622-2112
  • Fax: 603-624-1570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number9753
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number9753
License Number StateNH

VIII. Authorized Official

Name: DR. HOWARD LEE SULS
Title or Position: OWNER
Credential: M.D.
Phone: 603-622-2112