Healthcare Provider Details

I. General information

NPI: 1821030511
Provider Name (Legal Business Name): CARL CIAK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 04/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 PLEASANT ST
CONCORD NH
03301-7539
US

IV. Provider business mailing address

248 PLEASANT ST SUITE 2800
CONCORD NH
03301-2588
US

V. Phone/Fax

Practice location:
  • Phone: 603-224-4003
  • Fax: 603-228-7031
Mailing address:
  • Phone: 603-224-4003
  • Fax: 603-228-7031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number11866
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: