Healthcare Provider Details

I. General information

NPI: 1699107268
Provider Name (Legal Business Name): LAUREN GELINAS PA-C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2013
Last Update Date: 07/12/2021
Certification Date: 07/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

138 WEBSTER STREET
MANCHESTER NH
03104
US

IV. Provider business mailing address

PO BOX 3300
MANCHESTER NH
03105
US

V. Phone/Fax

Practice location:
  • Phone: 603-645-5977
  • Fax: 603-645-5980
Mailing address:
  • Phone: 603-645-5977
  • Fax: 603-645-5980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1067
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: