Healthcare Provider Details

I. General information

NPI: 1396215323
Provider Name (Legal Business Name): LINDSAY GOODE SPINALE RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LINDSAY GOODE FILICICCHIA RD

II. Dates (important events)

Enumeration Date: 12/03/2018
Last Update Date: 12/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

239 PLEASANT STREET
CONCORD NH
03301
US

IV. Provider business mailing address

834 MAMMOTH RD. APT 9
MANCHESTER NH
03104
US

V. Phone/Fax

Practice location:
  • Phone: 603-224-6561
  • Fax:
Mailing address:
  • Phone: 603-265-0575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number0746
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: