Healthcare Provider Details

I. General information

NPI: 1700823077
Provider Name (Legal Business Name): STEPHEN P. IMGRUND MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 07/30/2020
Certification Date: 07/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 PLEASANT ST
CONCORD NH
03301-7539
US

IV. Provider business mailing address

246 PLEASANT STREET MEMORIAL BUILDING, WEST, GROUND FLO
CONCORD NH
03301-2588
US

V. Phone/Fax

Practice location:
  • Phone: 603-224-9661
  • Fax: 603-228-7051
Mailing address:
  • Phone: 603-224-9661
  • Fax: 603-228-7051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number7052
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: