Healthcare Provider Details

I. General information

NPI: 1063893055
Provider Name (Legal Business Name): STEPHANIE CULL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2015
Last Update Date: 08/24/2021
Certification Date: 08/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

246 PLEASANT ST. MEMORIAL BUILDING, WEST, GROUND FLOOR
CONCORD NH
03301-2548
US

IV. Provider business mailing address

246 PLEASANT ST. MEMORIAL BUILDING, WEST, GROUND FLOOR
CONCORD NH
03301-2548
US

V. Phone/Fax

Practice location:
  • Phone: 603-224-9661
  • Fax: 603-227-7528
Mailing address:
  • Phone: 603-224-9661
  • Fax: 603-227-7528

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036146294
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number20800
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: