Healthcare Provider Details

I. General information

NPI: 1013545011
Provider Name (Legal Business Name): ISABELLE LAURENCE MAGRO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2020
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 COMMERCIAL ST STE 401
CONCORD NH
03301-5096
US

IV. Provider business mailing address

250 PLEASANT ST
CONCORD NH
03301-2598
US

V. Phone/Fax

Practice location:
  • Phone: 603-789-9150
  • Fax:
Mailing address:
  • Phone: 603-227-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number40076
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License NumberA187302
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: