Healthcare Provider Details

I. General information

NPI: 1073009809
Provider Name (Legal Business Name): FARKHAT GALIULLIN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2018
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 HIGHLAND ST
LACONIA NH
03246-3235
US

IV. Provider business mailing address

80 HIGHLAND ST
LACONIA NH
03246-3235
US

V. Phone/Fax

Practice location:
  • Phone: 603-524-3211
  • Fax: 603-737-6713
Mailing address:
  • Phone: 603-524-3211
  • Fax: 603-527-2887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number35.156691
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number21219
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: