Healthcare Provider Details

I. General information

NPI: 1801953260
Provider Name (Legal Business Name): ROBERT M DAGOSTINO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 10/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 JONES RD
MILFORD NH
03055-3100
US

IV. Provider business mailing address

10 JONES RD
MILFORD NH
03055-3100
US

V. Phone/Fax

Practice location:
  • Phone: 603-672-7600
  • Fax: 603-672-6274
Mailing address:
  • Phone: 603-672-7600
  • Fax: 603-672-6274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number7944
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: