Healthcare Provider Details

I. General information

NPI: 1740579176
Provider Name (Legal Business Name): DAVID DE GIJSEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2011
Last Update Date: 06/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL CENTER DR DHMC SECTION OF INFECTIOUS DISEASE
LEBANON NH
03756-1000
US

IV. Provider business mailing address

1 MEDICAL CENTER DR DHMC
LEBANON NH
03756-1000
US

V. Phone/Fax

Practice location:
  • Phone: 603-650-6060
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number18235
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number18235
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: