Healthcare Provider Details

I. General information

NPI: 1669303590
Provider Name (Legal Business Name): EDWARD WELLES M.ED
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 PINE STREET EXT
NASHUA NH
03060-3213
US

IV. Provider business mailing address

100 W PEARL ST
NASHUA NH
03060-3343
US

V. Phone/Fax

Practice location:
  • Phone: 603-889-6147
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: