Healthcare Provider Details

I. General information

NPI: 1679747414
Provider Name (Legal Business Name): KATE RIDDELL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHLEEN RICHARD MD

II. Dates (important events)

Enumeration Date: 04/14/2008
Last Update Date: 09/15/2021
Certification Date: 09/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 PROSPECT ST DEPT OF
NASHUA NH
03060-3925
US

IV. Provider business mailing address

77 SOUTH RD
EAST KINGSTON NH
03827-2125
US

V. Phone/Fax

Practice location:
  • Phone: 603-577-2000
  • Fax:
Mailing address:
  • Phone: 603-772-5501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number15937
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number15937
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: