Healthcare Provider Details

I. General information

NPI: 1275616500
Provider Name (Legal Business Name): PEAK INTERNAL MEDICINE ASSOC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 01/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 ROCKINGHAM RD STE 103
WINDHAM NH
03087-1360
US

IV. Provider business mailing address

127 ROCKINGHAM RD STE 103
WINDHAM NH
03087-1360
US

V. Phone/Fax

Practice location:
  • Phone: 603-890-0266
  • Fax: 603-890-0267
Mailing address:
  • Phone: 603-890-0266
  • Fax: 603-890-0267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number10943
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number10943
License Number StateNH

VIII. Authorized Official

Name: LISA MARIE HATZOS
Title or Position: PROPRIETOR
Credential: MD
Phone: 603-890-0266