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General NPI Number Information
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NPI Number | 1255845905
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Entity Type | Organization
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Legal Business Name | EXPRESSMED, LLC
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Dates
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Enumeration Date | 11/16/2017
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Last Update Date | 11/16/2017
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Provider Practice Location Address
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Address Line | 152 COLBY STREET
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City | COLEBROOK
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State | NH
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Zip | 03576
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Country | US
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Telephone | 603-331-0500
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Fax |
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Provider Business Mailing Address
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Address Line | 700 LAKE AVE STE 2
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City | MANCHESTER
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State | NH
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Zip | 03103
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Country | US
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Telephone | 603-782-8374
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Fax | 603-782-5123
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | NICHOLAS VAILAS
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Credential |
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Telephone | 603-622-3670
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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