Healthcare Provider Details

I. General information

NPI: 1407902323
Provider Name (Legal Business Name): RICHARD J. LORENZ JR. PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 04/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 PAGE HILL RD
BERLIN NH
03570-3531
US

IV. Provider business mailing address

59 PAGE HILL RD
BERLIN NH
03570-3531
US

V. Phone/Fax

Practice location:
  • Phone: 603-752-2200
  • Fax: 603-752-8231
Mailing address:
  • Phone: 603-752-2200
  • Fax: 603-752-8231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0397 P
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: