Healthcare Provider Details

I. General information

NPI: 1760896849
Provider Name (Legal Business Name): DOUGLAS MICHAEL PHELAN DO, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2014
Last Update Date: 09/12/2023
Certification Date: 09/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 RANGE RD STE 104
WINDHAM NH
03087-2029
US

IV. Provider business mailing address

6 BUTTRICK RD STE 102
LONDONDERRY NH
03053-3417
US

V. Phone/Fax

Practice location:
  • Phone: 603-537-1300
  • Fax: 603-328-0181
Mailing address:
  • Phone: 603-537-1300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number19603
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: