Healthcare Provider Details

I. General information

NPI: 1568624005
Provider Name (Legal Business Name): VANITA K JAIN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2008
Last Update Date: 09/26/2024
Certification Date: 09/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 PLEASANT ST
CONCORD NH
03301-2598
US

IV. Provider business mailing address

250 PLEASANT ST
CONCORD NH
03301-7559
US

V. Phone/Fax

Practice location:
  • Phone: 603-789-9103
  • Fax: 603-227-7832
Mailing address:
  • Phone: 603-789-9103
  • Fax: 603-227-7832

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number16826
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: