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General NPI Number Information
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NPI Number | 1003423724
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Entity Type | Organization
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Legal Business Name | GRANITE STATE GERIATRICS PLLC
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Dates
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Enumeration Date | 09/27/2020
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Last Update Date | 09/27/2020
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Provider Practice Location Address
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Address Line | 635 MAIN ST STE 303
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City | LACONIA
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State | NH
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Zip | 03246-3415
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Country | US
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Telephone | 603-409-0735
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Fax | 877-919-0640
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Provider Business Mailing Address
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Address Line | 32 HARVEST RUN
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City | GILFORD
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State | NH
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Zip | 03249-6567
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | DR. RAYMOND EDWIN SUAREZ
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Credential |
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Telephone | 603-409-0735
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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