Healthcare Provider Details

I. General information

NPI: 1831191659
Provider Name (Legal Business Name): ELLIOT PHYSICIANS NETWORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2005
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1070 HOLT AVENUE UNIT 1 SUITE 2200
MANCHESTER NH
03109
US

IV. Provider business mailing address

1070 HOLT AVE UNIT 1 SUITE 2200
MANCHESTER NH
03109-5603
US

V. Phone/Fax

Practice location:
  • Phone: 603-663-4900
  • Fax: 603-663-4984
Mailing address:
  • Phone: 603-663-4900
  • Fax: 603-663-4984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateNH
# 3
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number StateNH
# 4
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateNH
# 5
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number03977
License Number StateNH

VIII. Authorized Official

Name: RICHARD P. HERMAN
Title or Position: DIRECTOR OF OPERATIONS & FINANCE
Credential:
Phone: 603-663-4904