Healthcare Provider Details

I. General information

NPI: 1306396452
Provider Name (Legal Business Name): INSIGHT MEDICAL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2016
Last Update Date: 04/02/2020
Certification Date: 04/02/2020
Deactivation Date: 09/22/2018
Reactivation Date: 01/24/2020

III. Provider practice location address

861 LAFAYETTE RD UNIT 6
HAMPTON NH
03842-1232
US

IV. Provider business mailing address

861 LAFAYETTE RD UNIT 6
HAMPTON NH
03842-1232
US

V. Phone/Fax

Practice location:
  • Phone: 978-267-1193
  • Fax: 888-979-8717
Mailing address:
  • Phone: 978-267-1193
  • Fax: 888-979-8717

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number046771-23
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number046771-23
License Number StateNH
# 3
Primary TaxonomyN
Taxonomy Code261QR0800X
TaxonomyRecovery Care Clinic/Center
License Number046771-23
License Number StateNH

VIII. Authorized Official

Name: MR. ROBERT E DILLON JR.
Title or Position: PARTNER/PRACTITIONER
Credential: NP
Phone: 978-267-1193