Healthcare Provider Details

I. General information

NPI: 1366929440
Provider Name (Legal Business Name): WENTWORTH DOUGLASS HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2018
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701B CENTRAL AVE
DOVER NH
03820-3403
US

IV. Provider business mailing address

PO BOX 412540
BOSTON MA
02241-2540
US

V. Phone/Fax

Practice location:
  • Phone: 603-609-6700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOEL DEGENAARS
Title or Position: EXECUTIVE DIRECTOR OF FINANCE
Credential:
Phone: 603-740-2806