Healthcare Provider Details

I. General information

NPI: 1134118318
Provider Name (Legal Business Name): PARKLAND PHYSICIAN SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2005
Last Update Date: 01/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 BIRCH ST SUITE 200
DERRY NH
03038-2752
US

IV. Provider business mailing address

44 BIRCH ST SUITE 200
DERRY NH
03038-2752
US

V. Phone/Fax

Practice location:
  • Phone: 603-421-2432
  • Fax: 603-421-2435
Mailing address:
  • Phone: 603-421-2432
  • Fax: 603-421-2435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: KENNETH WASHINGTON
Title or Position: VICE PRESIDENT
Credential:
Phone: 703-650-2907