Healthcare Provider Details

I. General information

NPI: 1013522994
Provider Name (Legal Business Name): WENTWORTH DOUGLASS HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2020
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 ROUTE 108 STE 3
SOMERSWORTH NH
03878-1119
US

IV. Provider business mailing address

PO BOX 412540
BOSTON MA
02241-2540
US

V. Phone/Fax

Practice location:
  • Phone: 603-742-6673
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2471B0102X
TaxonomyBone Densitometry Radiologic Technologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0206X
TaxonomyMammography Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOEL DEGENAARS
Title or Position: EXECUTIVE DIRECTOR OF FINANCE
Credential:
Phone: 617-726-3884