Healthcare Provider Details

I. General information

NPI: 1811921836
Provider Name (Legal Business Name): DR. JOHN GEMERY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 07/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL CENTER DR DEPARTMENT OF RADIOLOGY
LEBANON NH
03756-1000
US

IV. Provider business mailing address

1 MEDICAL CENTER DR DEPARTMENT OF RADIOLOGY
LEBANON NH
03756-1000
US

V. Phone/Fax

Practice location:
  • Phone: 603-650-7230
  • Fax: 603-650-5455
Mailing address:
  • Phone: 603-650-4477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number10387
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: