Healthcare Provider Details

I. General information

NPI: 1922184928
Provider Name (Legal Business Name): LRGHEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 05/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 HIGHLAND ST
LACONIA NH
03246-3235
US

IV. Provider business mailing address

PO BOX 4144
WOBURN MA
01888-4144
US

V. Phone/Fax

Practice location:
  • Phone: 603-524-3211
  • Fax:
Mailing address:
  • Phone: 603-524-3211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number00061
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number00061
License Number StateNH
# 3
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number00061
License Number StateNH
# 4
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number00061
License Number StateNH

VIII. Authorized Official

Name: HENRY D LIPMAN
Title or Position: CHIEF FINANCIAL OFFICER
Credential: EVP-CFO
Phone: 603-524-3211