Healthcare Provider Details

I. General information

NPI: 1013662766
Provider Name (Legal Business Name): IDOC TELEHEALTH SOLUTIONS NEW HAMPSHIRE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2022
Last Update Date: 08/23/2023
Certification Date: 08/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

789 CENTRAL AVE
DOVER NH
03820-2526
US

IV. Provider business mailing address

1 GATEWAY CTR STE 507
NEWTON MA
02458-2802
US

V. Phone/Fax

Practice location:
  • Phone: 346-633-8153
  • Fax:
Mailing address:
  • Phone: 713-913-1422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MELISSA ANN RENTERIA
Title or Position: MANAGER
Credential:
Phone: 346-633-8153