Healthcare Provider Details

I. General information

NPI: 1871126581
Provider Name (Legal Business Name): ERNEST K TABIRI PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2020
Last Update Date: 03/23/2023
Certification Date: 03/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 NORTHWEST BLVD
NASHUA NH
03063-4068
US

IV. Provider business mailing address

29 NORTHWEST BLVD
NASHUA NH
03063-4068
US

V. Phone/Fax

Practice location:
  • Phone: 603-577-2273
  • Fax:
Mailing address:
  • Phone: 603-577-2273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1651
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: