=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043214711
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GREGORY J THESING M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/09/2005
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15 ANTRIM RD HDFH
-----------------------------------------------------
City | HILLSBORO
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03244-5204
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-464-3434
-----------------------------------------------------
Fax | 603-464-3440
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15 ANTRIM RD HDFH
-----------------------------------------------------
City | HILLSBORO
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03244-5204
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-464-3434
-----------------------------------------------------
Fax | 603-464-3440
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 9755
-----------------------------------------------------
License Number State | NH
-----------------------------------------------------