Healthcare Provider Details

I. General information

NPI: 1669659793
Provider Name (Legal Business Name): JEREMY GIERE COLLINS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2008
Last Update Date: 09/08/2021
Certification Date: 09/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46 S. MAIN ST. SUITE 2
CONCORD NH
03301
US

IV. Provider business mailing address

46 S. MAIN ST. SUITE 2
CONCORD NH
03301
US

V. Phone/Fax

Practice location:
  • Phone: 603-622-8665
  • Fax: 833-413-4978
Mailing address:
  • Phone: 603-622-8665
  • Fax: 833-413-4978

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number16634
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number253233
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberC1-0009679
License Number StateDE
# 4
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number16634
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: