Healthcare Provider Details

I. General information

NPI: 1427047695
Provider Name (Legal Business Name): EDWARD J FARMLETT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2005
Last Update Date: 11/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

87 SPRING ST SUITE 101
LACONIA NH
03246-3156
US

IV. Provider business mailing address

PO BOX 4110 DEPARTMENT 3340
WOBURN MA
01888-4110
US

V. Phone/Fax

Practice location:
  • Phone: 603-524-3211
  • Fax: 603-524-0089
Mailing address:
  • Phone: 603-524-3211
  • Fax: 603-524-0089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number7611
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: