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General NPI Number Information
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NPI Number | 1295179984
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Entity Type | Individual
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Provider Name | JUSTIN PLAUM D.O.
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Gender | Male
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Dates
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Enumeration Date | 04/24/2013
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Last Update Date | 08/03/2018
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Provider Practice Location Address
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Address Line | 49 RANGE RD STE 104
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City | WINDHAM
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State | NH
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Zip | 03087
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Country | US
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Telephone | 603-537-1300
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Fax |
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Provider Business Mailing Address
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Address Line | 6 BUTTRICK RD STE 102
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City | LONDONDERRY
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State | NH
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Zip | 03053-3417
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Country | US
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Telephone | 603-537-1300
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Fax |
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | OT015088
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License Number State | PA
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