Healthcare Provider Details

I. General information

NPI: 1427219948
Provider Name (Legal Business Name): THOR AGUSTSSON DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2008
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

148 COOLIDGE AVE
MANCHESTER NH
03102-3493
US

IV. Provider business mailing address

4800 N SCOTTSDALE RD STE 2500
SCOTTSDALE AZ
85251-7630
US

V. Phone/Fax

Practice location:
  • Phone: 603-883-0005
  • Fax: 603-883-0007
Mailing address:
  • Phone: 603-883-0005
  • Fax: 603-883-0007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number17292
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: