Healthcare Provider Details

I. General information

NPI: 1316214646
Provider Name (Legal Business Name): MONADNOCK ORTHOPAEDIC ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2011
Last Update Date: 12/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

458 OLD STREET RD SUITE 200
PETERBOROUGH NH
03458-1265
US

IV. Provider business mailing address

452 OLD STREET RD
PETERBOROUGH NH
03458-1263
US

V. Phone/Fax

Practice location:
  • Phone: 603-924-2144
  • Fax:
Mailing address:
  • Phone: 603-924-7191
  • Fax: 603-924-9586

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: RICHARD D SCHEINBLUM
Title or Position: CFO
Credential:
Phone: 603-924-7191