Healthcare Provider Details

I. General information

NPI: 1558538470
Provider Name (Legal Business Name): ELLIOT PROFESSIONAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2008
Last Update Date: 06/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 CYPRESS ST STE 7 ELLIOT ENDOCRINOLOGY ASSOCIATES
MANCHESTER NH
03103-3600
US

IV. Provider business mailing address

445 CYPRESS ST STE 7 ELLIOT ENDOCRINOLOGY ASSOCIATES
MANCHESTER NH
03103-3600
US

V. Phone/Fax

Practice location:
  • Phone: 603-663-3740
  • Fax: 603-663-3749
Mailing address:
  • Phone: 603-663-3740
  • Fax: 603-663-3749

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State

VIII. Authorized Official

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