Healthcare Provider Details

I. General information

NPI: 1245205046
Provider Name (Legal Business Name): LACONIA CARDIOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 11/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

369 HOUNSELL AVENUE SUITE #5
GILFORD NH
03249
US

IV. Provider business mailing address

369 HOUNSELL AVENUE
GILFORD NH
03249
US

V. Phone/Fax

Practice location:
  • Phone: 603-528-8555
  • Fax: 603-528-7668
Mailing address:
  • Phone: 603-528-8555
  • Fax: 603-528-7668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: MARY CLAIRE PAICOPOLIS
Title or Position: SOLE OWNER- 2009
Credential: MD, FACC
Phone: 603-528-8555