Healthcare Provider Details

I. General information

NPI: 1316445927
Provider Name (Legal Business Name): GRANITE STATE PODIATRY ASSOCIATES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2018
Last Update Date: 01/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 S RIVER RD # 2300
BEDFORD NH
03110-6927
US

IV. Provider business mailing address

424 HANOVER ST
MANCHESTER NH
03104-5101
US

V. Phone/Fax

Practice location:
  • Phone: 603-668-3509
  • Fax: 603-641-8442
Mailing address:
  • Phone: 603-668-3509
  • Fax: 603-641-8442

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: ELLEN YUSE
Title or Position: OFFICE MANAGER
Credential:
Phone: 603-668-3509