Healthcare Provider Details

I. General information

NPI: 1619057080
Provider Name (Legal Business Name): EXETER CARDIOVASCULAR ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 ALUMNI DR SUITE 101
EXETER NH
03833-2119
US

IV. Provider business mailing address

3 ALUMNI DR SUITE 101
EXETER NH
03833-2119
US

V. Phone/Fax

Practice location:
  • Phone: 603-773-9992
  • Fax: 603-778-6393
Mailing address:
  • Phone: 603-773-9992
  • Fax: 603-778-6393

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. DIANA L GILBERT
Title or Position: PRACTICE ADMINISTRATOR
Credential: CMPE
Phone: 603-773-9992