Healthcare Provider Details

I. General information

NPI: 1730325325
Provider Name (Legal Business Name): ELLIOT PROFESSIONAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2009
Last Update Date: 10/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 CHAMBERS ROAD ELLIOT PEDIATRIC SPECIALISTS
HOOKSETT NH
03106-1826
US

IV. Provider business mailing address

20 CHAMBERS ROAD ELLIOT PEDIATRIC SPECIALISTS
HOOKSETT NH
03106-1826
US

V. Phone/Fax

Practice location:
  • Phone: 603-647-0052
  • Fax: 603-626-8016
Mailing address:
  • Phone: 603-647-0052
  • Fax: 603-626-8016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateNH

VIII. Authorized Official

Name: RICHARD P HERMAN
Title or Position: DIRECTOR OF OPERATIONS & FINANCE
Credential:
Phone: 603-663-4904