Healthcare Provider Details

I. General information

NPI: 1154543593
Provider Name (Legal Business Name): PORTSMOUTH INTERNAL MEDICINE ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 BORTHWICK AVE SUITE 205
PORTSMOUTH NH
03801-4174
US

IV. Provider business mailing address

330 BORTHWICK AVE SUITE 205
PORTSMOUTH NH
03801-4174
US

V. Phone/Fax

Practice location:
  • Phone: 603-426-6115
  • Fax: 603-433-5567
Mailing address:
  • Phone: 603-426-6115
  • Fax: 603-433-5567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: CHARLES C PINKERTON
Title or Position: PRESIDENT
Credential: M.D.
Phone: 603-426-6115