Healthcare Provider Details

I. General information

NPI: 1831055680
Provider Name (Legal Business Name): MICHAEL DYMEK CRSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/24/2025
Last Update Date: 12/24/2025
Certification Date: 12/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 S STATE ST
CONCORD NH
03301-3528
US

IV. Provider business mailing address

112 S STATE ST
CONCORD NH
03301-3528
US

V. Phone/Fax

Practice location:
  • Phone: 603-532-0720
  • Fax:
Mailing address:
  • Phone: 603-532-0720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number0418
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: