Healthcare Provider Details

I. General information

NPI: 1598042798
Provider Name (Legal Business Name): ELLIOT PROFESSIONAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2011
Last Update Date: 11/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 QUEEN CITY AVE ELLIOT RHEUMATOLOGY ASSOCIATES
MANCHESTER NH
03101-7121
US

IV. Provider business mailing address

185 QUEEN CITY AVE ELLIOT RHEUMATOLOGY ASSOCIATES
MANCHESTER NH
03101-7121
US

V. Phone/Fax

Practice location:
  • Phone: 603-625-1655
  • Fax: 603-626-4686
Mailing address:
  • Phone: 603-625-1655
  • Fax: 603-626-4686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number State

VIII. Authorized Official

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