Healthcare Provider Details

I. General information

NPI: 1164409892
Provider Name (Legal Business Name): GREGORY CHARLES FANARAS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2005
Last Update Date: 05/09/2023
Certification Date: 05/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

166 KINSLEY ST
NASHUA NH
03060-3676
US

IV. Provider business mailing address

330 BORTHWICK AVE SUITE 108
PORTSMOUTH NH
03801-4174
US

V. Phone/Fax

Practice location:
  • Phone: 603-889-4131
  • Fax: 603-889-6419
Mailing address:
  • Phone: 603-436-4614
  • Fax: 603-436-0377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberMD19307
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number5927
License Number StateNH
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD19307
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: