Healthcare Provider Details

I. General information

NPI: 1750487682
Provider Name (Legal Business Name): THOMAS S PEDERSEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 12/28/2023
Certification Date: 12/28/2023
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 Number12352
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: