Healthcare Provider Details

I. General information

NPI: 1992908644
Provider Name (Legal Business Name): MANCHESTER COMMUNITY HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2007
Last Update Date: 12/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 HOLLIS ST
MANCHESTER NH
03101-1235
US

IV. Provider business mailing address

1245 ELM STREET,
MANCHESTER NH
03101
US

V. Phone/Fax

Practice location:
  • Phone: 603-668-6629
  • Fax: 603-622-7680
Mailing address:
  • Phone: 602-668-6629
  • Fax: 603-622-7680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: LISA A. DIBRIGIDA, MD
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 603-668-6629