Healthcare Provider Details

I. General information

NPI: 1235232455
Provider Name (Legal Business Name): PAUL FREDERICK BELLIVEAU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 05/23/2022
Certification Date: 05/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 HAMPTON RD STE 2
EXETER NH
03833-4807
US

IV. Provider business mailing address

9 HAMPTON RD UNIT 2
EXETER NH
03833-4807
US

V. Phone/Fax

Practice location:
  • Phone: 602-778-0505
  • Fax: 603-772-6761
Mailing address:
  • Phone: 603-778-0505
  • Fax: 603-772-6761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number10577
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: