Healthcare Provider Details

I. General information

NPI: 1801890629
Provider Name (Legal Business Name): HAROLD J PIKUS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 11/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 HANOVER ST
LEBANON NH
03766-1042
US

IV. Provider business mailing address

106 HANOVER ST
LEBANON NH
03766-1042
US

V. Phone/Fax

Practice location:
  • Phone: 603-448-0447
  • Fax:
Mailing address:
  • Phone: 603-448-0447
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number200100593
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: