Healthcare Provider Details

I. General information

NPI: 1407589070
Provider Name (Legal Business Name): WENTWORTH DOUGLASS HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2022
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 CORPORATE DR
PORTSMOUTH NH
03801-2847
US

IV. Provider business mailing address

PO BOX 412504
BOSTON MA
02241-2504
US

V. Phone/Fax

Practice location:
  • Phone: 603-742-2163
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOEL DEGENAARS
Title or Position: EXECUTIVE DIRECTOR OF FINANCE
Credential:
Phone: 603-740-2806