Healthcare Provider Details

I. General information

NPI: 1205047032
Provider Name (Legal Business Name): OCCUPATIONAL HEALTH SERVICES OF PORTSMOUTH REGIONAL HOSPITAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 03/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 NEW HAMPSHIRE AVE SUITE 105
PORTSMOUTH NH
03801-2841
US

IV. Provider business mailing address

25 NEW HAMPSHIRE AVE SUITE 105
PORTSMOUTH NH
03801-2841
US

V. Phone/Fax

Practice location:
  • Phone: 603-430-9675
  • Fax: 603-334-6088
Mailing address:
  • Phone: 603-430-9675
  • Fax: 603-334-6088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number StateNH

VIII. Authorized Official

Name: MR. WILLIAM DOOLEY
Title or Position: MANAGER
Credential: PT
Phone: 603-430-9675