Healthcare Provider Details

I. General information

NPI: 1497345706
Provider Name (Legal Business Name): CALVIN KNOWLES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2021
Last Update Date: 06/28/2026
Certification Date: 06/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

59 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:
Mailing address:
  • Phone: 603-752-2200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2041
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: