Healthcare Provider Details

I. General information

NPI: 1023431897
Provider Name (Legal Business Name): GEROMED PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2014
Last Update Date: 01/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

334 COLLEGE HILL RD
HOPKINTON NH
03229-3404
US

IV. Provider business mailing address

334 COLLEGE HILL RD
HOPKINTON NH
03229-3404
US

V. Phone/Fax

Practice location:
  • Phone: 603-746-4164
  • Fax: 603-746-3522
Mailing address:
  • Phone: 603-746-4164
  • Fax: 603-746-3522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License Number6975
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number6975
License Number StateNH

VIII. Authorized Official

Name: MS. PAULINE M MERIDIEN
Title or Position: CORPORATE SECRETARY
Credential:
Phone: 603-746-4164