Healthcare Provider Details

I. General information

NPI: 1356879548
Provider Name (Legal Business Name): NEW ENGLAND MEDICINE AND COUNSELING ASSOCIATES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 ROUTE 10 N
GRANTHAM NH
03753-3619
US

IV. Provider business mailing address

PO BOX 797
GRANTHAM NH
03753-0797
US

V. Phone/Fax

Practice location:
  • Phone: 603-903-2900
  • Fax: 603-676-4614
Mailing address:
  • Phone: 603-903-2900
  • Fax: 603-676-4614

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number743884
License Number StateNH

VIII. Authorized Official

Name: AMY FECTEAU
Title or Position: VICE PRESIDENT OF OPERATIONS
Credential:
Phone: 603-903-2900