Healthcare Provider Details

I. General information

NPI: 1861503567
Provider Name (Legal Business Name): CHRISTOPHER CHILDS DAIGLE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 05/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

166 KINSLEY ST STE 101
NASHUA NH
03060-3676
US

IV. Provider business mailing address

C/O ST MARY'S HEALTH SYSTEM PO BOX 7291
LEWISTON ME
04243-7291
US

V. Phone/Fax

Practice location:
  • Phone: 603-889-4131
  • Fax: 603-889-6419
Mailing address:
  • Phone: 207-777-8695
  • Fax: 207-777-8800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number11656
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number11656
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: