Healthcare Provider Details

I. General information

NPI: 1942278403
Provider Name (Legal Business Name): BRIAN D KLAGGES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2006
Last Update Date: 10/01/2024
Certification Date: 10/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 RIVERSIDE ST STE 101
NASHUA NH
03062-1383
US

IV. Provider business mailing address

17 RIVERSIDE ST STE 101
NASHUA NH
03062-1383
US

V. Phone/Fax

Practice location:
  • Phone: 603-883-0091
  • Fax: 603-881-3739
Mailing address:
  • Phone: 603-883-0091
  • Fax: 603-881-3739

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number215980
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number13500
License Number StateNH
# 3
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number215980
License Number StateMA
# 4
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number13500
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: