Healthcare Provider Details

I. General information

NPI: 1528083250
Provider Name (Legal Business Name): MATTHEW P WARDEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MATTHEW P WARDEN M.D.

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 03/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 PLEASANT ST
CONCORD NH
03301-7539
US

IV. Provider business mailing address

250 PLEASANT ST
CONCORD NH
03301-7539
US

V. Phone/Fax

Practice location:
  • Phone: 603-227-7000
  • Fax:
Mailing address:
  • Phone: 603-227-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PE0005X
TaxonomyUndersea and Hyperbaric Medicine (Emergency Medicine) Physician
License Number214181
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number14153
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: