Healthcare Provider Details

I. General information

NPI: 1568704567
Provider Name (Legal Business Name): MY FRIEND'S GYNECOLOGIST LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2013
Last Update Date: 03/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

839 CENTRAL AVE SUITE ONE
DOVER NH
03820-2506
US

IV. Provider business mailing address

839 CENTRAL AVE SUITE ONE
DOVER NH
03820-2506
US

V. Phone/Fax

Practice location:
  • Phone: 603-516-0000
  • Fax: 603-516-5001
Mailing address:
  • Phone: 603-516-0000
  • Fax: 603-516-5001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number10011
License Number StateNH

VIII. Authorized Official

Name: DR. TERESA MARIE VANDERLINDE
Title or Position: MANAGING PARTNER
Credential: D.O.
Phone: 603-516-0000