Healthcare Provider Details

I. General information

NPI: 1609219369
Provider Name (Legal Business Name): MICHAEL DESIMONE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2013
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 QUEEN CITY AVE
MANCHESTER NH
03101-7121
US

IV. Provider business mailing address

185 QUEEN CITY AVE
MANCHESTER NH
03101-7121
US

V. Phone/Fax

Practice location:
  • Phone: 603-314-6900
  • Fax: 603-314-6909
Mailing address:
  • Phone: 603-314-6900
  • Fax: 603-314-6909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number38916
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: