Healthcare Provider Details

I. General information

NPI: 1316026677
Provider Name (Legal Business Name): SOUTHERN NEW HAMPSHIRE INTERNAL MEDICINE ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 07/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 TSIENNETO RD SUITE 300
DERRY NH
03038-1584
US

IV. Provider business mailing address

6 TSIENNETO RD SUITE 300
DERRY NH
03038-1584
US

V. Phone/Fax

Practice location:
  • Phone: 603-216-0400
  • Fax: 603-216-3800
Mailing address:
  • Phone: 603-216-0400
  • Fax: 603-216-3800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MS. JEAN C COAKLEY
Title or Position: ADMINISTRATIVE MANAGER
Credential:
Phone: 603-216-0400