Healthcare Provider Details

I. General information

NPI: 1811973290
Provider Name (Legal Business Name): LAWRENCE M. DUBUSKE, MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 GILCREAST RD
LONDONDERRY NH
03053-3564
US

IV. Provider business mailing address

91 STILES RD
SALEM NH
03079-2846
US

V. Phone/Fax

Practice location:
  • Phone: 603-434-3565
  • Fax:
Mailing address:
  • Phone: 603-893-9784
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number
License Number StateMA

VIII. Authorized Official

Name: LAWRENCE DUBUSKE
Title or Position: MD
Credential: MD
Phone: 800-927-0002