Healthcare Provider Details

I. General information

NPI: 1558397695
Provider Name (Legal Business Name): GEROMED PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 07/31/2007
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 Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0560732308
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number11415
License Number StateNH
# 3
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number6975
License Number StateNH
# 4
Primary TaxonomyN
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License Number6975
License Number StateNH
# 5
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