Healthcare Provider Details

I. General information

NPI: 1457980070
Provider Name (Legal Business Name): JENNIFER R HALE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2020
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 QUEEN CITY AVE
MANCHESTER NH
03101-7121
US

IV. Provider business mailing address

185 QUEEN CITY AVE
MANCHESTER NH
03101-7121
US

V. Phone/Fax

Practice location:
  • Phone: 603-668-3067
  • Fax: 603-668-0164
Mailing address:
  • Phone: 603-668-3067
  • Fax: 603-668-0164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number35.153877
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number39627
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: