Healthcare Provider Details

I. General information

NPI: 1841478500
Provider Name (Legal Business Name): ELLIOT PROFESSIONAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2008
Last Update Date: 03/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 QUEEN CITY AVE ELLIOT GENERAL SURGICAL SPECIALISTS
MANCHESTER NH
03101-7100
US

IV. Provider business mailing address

185 QUEEN CITY AVE ELLIOT GENERAL SURGICAL SPECIALISTS
MANCHESTER NH
03101-7100
US

V. Phone/Fax

Practice location:
  • Phone: 603-627-1102
  • Fax: 603-647-5524
Mailing address:
  • Phone: 603-627-1102
  • Fax: 603-647-5524

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number
License Number State

VIII. Authorized Official

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