Healthcare Provider Details

I. General information

NPI: 1811537509
Provider Name (Legal Business Name): MADELEINE MARY GAMACHE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2020
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
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: 603-669-5300
  • Fax:
Mailing address:
  • Phone: 603-627-1102
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number1696
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: