Healthcare Provider Details

I. General information

NPI: 1770659831
Provider Name (Legal Business Name): RITA MARIA GELSOMINI GRUBER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RITA MARIA GRUBER MD

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 02/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1145 SAGAMORE AVE SEACOAST MENTAL HEALTH CENTER
PORTSMOUTH NH
03801-5503
US

IV. Provider business mailing address

1145 SAGAMORE AVE SEACOAST MENTAL HEALTH CENTER
PORTSMOUTH NH
03801-5503
US

V. Phone/Fax

Practice location:
  • Phone: 603-431-6703
  • Fax: 603-433-5078
Mailing address:
  • Phone: 603-431-6703
  • Fax: 603-433-5078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number12257
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number0420010742
License Number StateVT
# 3
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number12257
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: