Healthcare Provider Details

I. General information

NPI: 1205829132
Provider Name (Legal Business Name): AMY B NIEMAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/25/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PROSPECT ST 2ND FL
NASHUA NH
03060-3921
US

IV. Provider business mailing address

215 PAIGE HILL RD
GOFFSTOWN NH
03045-3034
US

V. Phone/Fax

Practice location:
  • Phone: 603-889-4431
  • Fax: 603-889-1572
Mailing address:
  • Phone: 603-497-4226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number8804
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: