Healthcare Provider Details

I. General information

NPI: 1780250738
Provider Name (Legal Business Name): AFFIRM MEDICAL GROUP PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2021
Last Update Date: 06/01/2021
Certification Date: 06/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 W PARK ST STE 421
LEBANON NH
03766-6308
US

IV. Provider business mailing address

20 W PARK ST STE 421
LEBANON NH
03766-6308
US

V. Phone/Fax

Practice location:
  • Phone: 603-276-0024
  • Fax:
Mailing address:
  • Phone: 603-276-0024
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. BENJAMIN BOH
Title or Position: OWNER
Credential: D.O.
Phone: 603-276-0024