Healthcare Provider Details

I. General information

NPI: 1063736288
Provider Name (Legal Business Name): ROBIN A HALLQUIST M.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2010
Last Update Date: 07/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

529 SOUTH ROUTE 3 SUITE 11
TWIN MOUNTAIN NH
03595
US

IV. Provider business mailing address

PO BOX 303
TWIN MOUNTAIN NH
03595-0303
US

V. Phone/Fax

Practice location:
  • Phone: 603-846-2250
  • Fax: 603-846-2251
Mailing address:
  • Phone: 603-846-2250
  • Fax: 603-846-2251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number11044
License Number StateNH

VIII. Authorized Official

Name: DR. ROBIN A. HALLQUIST
Title or Position: OWNER
Credential: M.D.
Phone: 603-846-2250