Healthcare Provider Details

I. General information

NPI: 1740210368
Provider Name (Legal Business Name): KENNETH DOUGLAS CALL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 07/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

89 N STATE ST
CONCORD NH
03301
US

IV. Provider business mailing address

89 N STATE ST
CONCORD NH
03301-4334
US

V. Phone/Fax

Practice location:
  • Phone: 603-931-3656
  • Fax:
Mailing address:
  • Phone: 603-931-3656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number13791
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number17654
License Number StateMS
# 3
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number94-00431
License Number StateNC
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number13791
License Number StateNH
# 5
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number17654
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: