Healthcare Provider Details

I. General information

NPI: 1467437822
Provider Name (Legal Business Name): DENNIS W COOMBS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2005
Last Update Date: 07/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 MASCOMA ST
LEBANON NH
03766-2647
US

IV. Provider business mailing address

397 HANOVER CENTER RD
ETNA NH
03750-4213
US

V. Phone/Fax

Practice location:
  • Phone: 603-443-9508
  • Fax: 603-443-9549
Mailing address:
  • Phone: 603-443-9508
  • Fax: 603-443-9549

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number5506
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: