Healthcare Provider Details

I. General information

NPI: 1811313620
Provider Name (Legal Business Name): PATRICK DESAMOURS PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2014
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 HIGHLAND ST
LACONIA NH
03246-3235
US

IV. Provider business mailing address

250 PLEASANT ST
CONCORD NH
03301-2598
US

V. Phone/Fax

Practice location:
  • Phone: 603-527-2819
  • Fax: 603-737-6713
Mailing address:
  • Phone: 603-227-7000
  • Fax: 603-230-7405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC0005311
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: