Healthcare Provider Details

I. General information

NPI: 1023191152
Provider Name (Legal Business Name): PHYSICIAN'S DIAGNOSTIC SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 MAIN ST
SALEM NH
03079-5900
US

IV. Provider business mailing address

11 WASHINGTON PL
BEDFORD NH
03110-6747
US

V. Phone/Fax

Practice location:
  • Phone: 603-898-0961
  • Fax:
Mailing address:
  • Phone: 603-622-3670
  • Fax: 603-622-9134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. SUE D MAJEWSKI
Title or Position: COO
Credential:
Phone: 603-622-3670