Healthcare Provider Details

I. General information

NPI: 1902872971
Provider Name (Legal Business Name): JAKOW DIENER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 07/21/2021
Certification Date: 07/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 BROOK RD
BETHLEHEM NH
03574-4342
US

IV. Provider business mailing address

360 BROOK RD
BETHLEHEM NH
03574-4342
US

V. Phone/Fax

Practice location:
  • Phone: 603-616-9916
  • Fax:
Mailing address:
  • Phone: 603-616-9916
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number12255
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: