Healthcare Provider Details

I. General information

NPI: 1679590012
Provider Name (Legal Business Name): GREGORY KRIEBEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 11/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

454 OLD STREET RD SUITE 106
PETERBOROUGH NH
03458-1200
US

IV. Provider business mailing address

454 OLD STREET RD SUITE 106
PETERBOROUGH NH
03458-1200
US

V. Phone/Fax

Practice location:
  • Phone: 603-924-7101
  • Fax: 603-924-6037
Mailing address:
  • Phone: 603-924-7101
  • Fax: 603-924-6037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number12306
License Number StateNH

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierRE7907
Identifier TypeOTHER
Identifier StateNH
Identifier IssuerMEDICARE PTAN
# 2
Identifier30204367
Identifier TypeMEDICAID
Identifier StateNH
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: