Healthcare Provider Details

I. General information

NPI: 1053275065
Provider Name (Legal Business Name): SAMANTHA L DAOUST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2025
Last Update Date: 12/13/2025
Certification Date: 12/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 EXECUTIVE PARK DR
MERRIMACK NH
03054-4002
US

IV. Provider business mailing address

4 EXECUTIVE PARK DR APT 413
MERRIMACK NH
03054-4091
US

V. Phone/Fax

Practice location:
  • Phone: 978-758-7027
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number081314-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: