Healthcare Provider Details

I. General information

NPI: 1699889378
Provider Name (Legal Business Name): DR. KIMBERLY A GIFFORD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 01/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL CENTER DR
LEBANON NH
03756-1000
US

IV. Provider business mailing address

1 MEDICAL CENTER DR
LEBANON NH
03756-1000
US

V. Phone/Fax

Practice location:
  • Phone: 603-653-9664
  • Fax: 603-650-0910
Mailing address:
  • Phone: 603-650-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number13205
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: