Healthcare Provider Details

I. General information

NPI: 1609807007
Provider Name (Legal Business Name): THOMAS P LEBOSQUET III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 12/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 BORTHWICK AVE EMERGENCY DEPT
PORTSMOUTH NH
03801-7128
US

IV. Provider business mailing address

333 BORTHWICK AVE EMERGENCY DEPT
PORTSMOUTH NH
03801-7128
US

V. Phone/Fax

Practice location:
  • Phone: 603-433-4012
  • Fax: 603-433-5184
Mailing address:
  • Phone: 603-433-4012
  • Fax: 603-433-5184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number13217
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number2012-02232
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: