Healthcare Provider Details

I. General information

NPI: 1780212415
Provider Name (Legal Business Name): NATHAN REDLICH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2020
Last Update Date: 09/26/2026
Certification Date: 09/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 MARSH BROOK DR STE 205
SOMERSWORTH NH
03878-6523
US

IV. Provider business mailing address

7 MARSH BROOK DR STE 205
SOMERSWORTH NH
03878-6523
US

V. Phone/Fax

Practice location:
  • Phone: 603-742-2007
  • Fax: 603-749-4605
Mailing address:
  • Phone: 603-742-2007
  • Fax: 603-749-4605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number39821
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number1022898
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: