Healthcare Provider Details

I. General information

NPI: 1659775575
Provider Name (Legal Business Name): CONCORD OPHTHALMOLOGIC ASSOCIATES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2014
Last Update Date: 10/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

248 PLEASANT ST SUITE 1600
CONCORD NH
03301-2588
US

IV. Provider business mailing address

2 PILLSBURY ST SUITE 100
CONCORD NH
03301-3523
US

V. Phone/Fax

Practice location:
  • Phone: 603-224-2020
  • Fax:
Mailing address:
  • Phone: 603-228-1104
  • Fax: 603-228-7061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number6873
License Number StateNH

VIII. Authorized Official

Name: ANDRE A D'HEMECOURT
Title or Position: OWNER
Credential: M.D.
Phone: 603-228-1104