Healthcare Provider Details

I. General information

NPI: 1740272517
Provider Name (Legal Business Name): DONALD KERNAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 BROADWAY AVE
GORHAM NH
03581-1502
US

IV. Provider business mailing address

133 PLEASANT ST
BERLIN NH
03570-2006
US

V. Phone/Fax

Practice location:
  • Phone: 603-466-2741
  • Fax: 603-466-2953
Mailing address:
  • Phone: 603-752-2040
  • Fax: 603-752-1709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number6901
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number6901
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: