Healthcare Provider Details

I. General information

NPI: 1639669260
Provider Name (Legal Business Name): JESSICA FORTIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2018
Last Update Date: 07/25/2022
Certification Date: 07/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 ALUMNI DR FL 2
EXETER NH
03833-2128
US

IV. Provider business mailing address

7 HOLLAND WAY FL 1
EXETER NH
03833-2997
US

V. Phone/Fax

Practice location:
  • Phone: 603-580-7525
  • Fax: 603-580-7542
Mailing address:
  • Phone: 603-580-7525
  • Fax: 603-580-7542

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number21216
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number21216
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: