Healthcare Provider Details

I. General information

NPI: 1659414589
Provider Name (Legal Business Name): PARKLAND PHYSICIAN SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 02/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 PELHAM RD
SALEM NH
03079-4818
US

IV. Provider business mailing address

18 PELHAM RD
SALEM NH
03079-4818
US

V. Phone/Fax

Practice location:
  • Phone: 603-894-0500
  • Fax: 603-894-0535
Mailing address:
  • Phone: 603-894-0500
  • Fax: 603-894-0535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: KENNETH WASHINGTON
Title or Position: VP
Credential:
Phone: 703-650-2907