Healthcare Provider Details

I. General information

NPI: 1114450228
Provider Name (Legal Business Name): JORGE EDUARDO SAONA CENTENO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2017
Last Update Date: 08/07/2024
Certification Date: 08/07/2024
Deactivation Date: 11/09/2017
Reactivation Date: 11/14/2017

III. Provider practice location address

333 BORTHWICK AVE STE 100
PORTSMOUTH NH
03801-4198
US

IV. Provider business mailing address

333 BORTHWICK AVE
PORTSMOUTH NH
03801-7128
US

V. Phone/Fax

Practice location:
  • Phone: 561-965-7300
  • Fax:
Mailing address:
  • Phone: 603-433-6931
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number20420
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number20420
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: