Healthcare Provider Details

I. General information

NPI: 1689705931
Provider Name (Legal Business Name): TRUSTEES OF DARTMOUTH COLLEGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 06/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 ROPE FERRY RD
HANOVER NH
03755-1404
US

IV. Provider business mailing address

7 ROPE FERRY RD # 6143
HANOVER NH
03755-1404
US

V. Phone/Fax

Practice location:
  • Phone: 603-646-9456
  • Fax: 603-646-9447
Mailing address:
  • Phone: 603-646-9456
  • Fax: 603-646-9447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License Number0012
License Number StateNH

VIII. Authorized Official

Name: GORDON TAYLOR
Title or Position: ASSOC DEAN AND EXECUTIVE OFFICER
Credential:
Phone: 603-646-9157