Healthcare Provider Details

I. General information

NPI: 1316597446
Provider Name (Legal Business Name): CENTER FOR KIDNEY DISEASE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2019
Last Update Date: 05/10/2026
Certification Date: 05/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 TSIENNETO RD STE 300A
DERRY NH
03038-1584
US

IV. Provider business mailing address

12 MOONSTONE CT
NASHUA NH
03062-3097
US

V. Phone/Fax

Practice location:
  • Phone: 603-912-2837
  • Fax: 949-810-9109
Mailing address:
  • Phone:
  • Fax: 949-810-9109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: SHAIKH R HOQUE
Title or Position: OWNER, AUTHORIZED SIGNER
Credential: MD
Phone: 406-788-7119