Healthcare Provider Details

I. General information

NPI: 1093743205
Provider Name (Legal Business Name): MATTHEW M HAND D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 11/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 ELLIOT WAY ELLIOT HOSPITAL - PEDIATRIC NEPHROLOGY
MANCHESTER NH
03103-3502
US

IV. Provider business mailing address

1 ELLIOT WAY ELLIOT HOSPITAL - PEDIATRIC NEPHROLOGY
MANCHESTER NH
03103-3502
US

V. Phone/Fax

Practice location:
  • Phone: 603-669-5300
  • Fax:
Mailing address:
  • Phone: 603-669-5300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License Number1501
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License Number15535
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: