Healthcare Provider Details

I. General information

NPI: 1134745078
Provider Name (Legal Business Name): CLARE ELIZABETH O'GRADY DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2020
Last Update Date: 08/21/2024
Certification Date: 08/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 PLEASANT ST
CONCORD NH
03301-2598
US

IV. Provider business mailing address

89 COLES LEDGE RD
BARNSTEAD NH
03218-3773
US

V. Phone/Fax

Practice location:
  • Phone: 603-225-7000
  • Fax:
Mailing address:
  • Phone: 603-391-8126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberRT-3643
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number032.0134200
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: