Healthcare Provider Details

I. General information

NPI: 1992913032
Provider Name (Legal Business Name): ANIL K DEWAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 11/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HAMPTON ROAD SUITE 208
EXETER NH
03833-4849
US

IV. Provider business mailing address

1 HAMPTON ROAD SUITE 208
EXETER NH
03833-4849
US

V. Phone/Fax

Practice location:
  • Phone: 603-778-8522
  • Fax: 603-778-1602
Mailing address:
  • Phone: 603-778-8522
  • Fax: 603-778-1602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number14583
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License Number0101239605
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: