Healthcare Provider Details

I. General information

NPI: 1497845101
Provider Name (Legal Business Name): EXETER EMERGENCY PHYSICIANS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 05/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 ALUMNI DR
EXETER NH
03833-2128
US

IV. Provider business mailing address

5 ALUMNI DR
EXETER NH
03833-2128
US

V. Phone/Fax

Practice location:
  • Phone: 603-580-6793
  • Fax: 603-580-7006
Mailing address:
  • Phone: 603-580-6793
  • Fax: 603-580-7006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier28317
Identifier TypeOTHER
Identifier State
Identifier IssuerBMC HEALTHNET PLAN
# 2
Identifier689149
Identifier TypeOTHER
Identifier State
Identifier IssuerTUFTS
# 3
Identifier101073100
Identifier TypeOTHER
Identifier State
Identifier IssuerOWCP
# 4
Identifier30211012
Identifier TypeMEDICAID
Identifier StateNH
Identifier Issuer
# 5
Identifier9703811
Identifier TypeMEDICAID
Identifier StateMA
Identifier Issuer
# 6
IdentifierCH5646
Identifier TypeOTHER
Identifier State
Identifier IssuerRAILROAD MEDICARE
# 7
Identifier142840000
Identifier TypeMEDICAID
Identifier StateME
Identifier Issuer

VIII. Authorized Official

Name: MARK JOSEPH
Title or Position: PRESIDENT/MEDICAL DIRECTOR
Credential: MD
Phone: 603-580-6793