Healthcare Provider Details

I. General information

NPI: 1104059237
Provider Name (Legal Business Name): ORION DIAGNOSTICS INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2009
Last Update Date: 08/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

138 ELM STREET
NEWPORT NH
03773-0025
US

IV. Provider business mailing address

P.O. BOX 25 138 ELM STREET
NEWPORT NH
03773-0025
US

V. Phone/Fax

Practice location:
  • Phone: 603-863-1260
  • Fax: 603-863-0750
Mailing address:
  • Phone: 603-863-1260
  • Fax: 603-863-0750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number1303
License Number StateNH

VIII. Authorized Official

Name: MARK C BISSELL
Title or Position: CEO
Credential: PHD
Phone: 603-863-9605