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General NPI Number Information
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NPI Number | 1164409892
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Entity Type | Individual
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Provider Name | GREGORY CHARLES FANARAS M.D.
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Gender | Male
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Dates
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Enumeration Date | 12/23/2005
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Last Update Date | 05/09/2023
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Provider Practice Location Address
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Address Line | 166 KINSLEY ST
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City | NASHUA
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State | NH
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Zip | 03060-3676
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Country | US
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Telephone | 603-889-4131
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Fax | 603-889-6419
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Provider Business Mailing Address
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Address Line | 330 BORTHWICK AVE SUITE 108
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City | PORTSMOUTH
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State | NH
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Zip | 03801-4174
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Country | US
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Telephone | 603-436-4614
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Fax | 603-436-0377
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | MD19307
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License Number State | RI
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Taxonomy #2
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 5927
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License Number State | NH
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MD19307
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License Number State | RI
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