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General NPI Number Information
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NPI Number | 1013662766
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Entity Type | Organization
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Legal Business Name | IDOC TELEHEALTH SOLUTIONS NEW HAMPSHIRE LLC
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Dates
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Enumeration Date | 02/21/2022
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Last Update Date | 08/23/2023
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Provider Practice Location Address
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Address Line | 789 CENTRAL AVE
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City | DOVER
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State | NH
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Zip | 03820-2526
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Country | US
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Telephone | 346-633-8153
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Fax |
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Provider Business Mailing Address
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Address Line | 1 GATEWAY CTR STE 507
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City | NEWTON
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State | MA
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Zip | 02458-2802
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Country | US
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Telephone | 713-913-1422
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MELISSA ANN RENTERIA
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Credential |
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Telephone | 346-633-8153
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LC0200X
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Taxonomy Name | Critical Care Medicine (Anesthesiology) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LC0200X
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Taxonomy Name | Critical Care Medicine Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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