Healthcare Provider Details

I. General information

NPI: 1073990669
Provider Name (Legal Business Name): SAMUEL JAMES OGDEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2015
Last Update Date: 02/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 ALICE PECK DAY DR
LEBANON NH
03766-2900
US

IV. Provider business mailing address

10 ALICE PECK DAY DR
LEBANON NH
03766-2900
US

V. Phone/Fax

Practice location:
  • Phone: 603-448-3121
  • Fax:
Mailing address:
  • Phone: 603-448-7440
  • Fax: 603-448-7444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number19082
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: