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General NPI Number Information
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NPI Number | 1316445927
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Entity Type | Organization
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Legal Business Name | GRANITE STATE PODIATRY ASSOCIATES PA
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Dates
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Enumeration Date | 01/29/2018
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Last Update Date | 01/29/2018
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Provider Practice Location Address
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Address Line | 160 S RIVER RD # 2300
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City | BEDFORD
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State | NH
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Zip | 03110-6927
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Country | US
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Telephone | 603-668-3509
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Fax | 603-641-8442
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Provider Business Mailing Address
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Address Line | 424 HANOVER ST
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City | MANCHESTER
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State | NH
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Zip | 03104-5101
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Country | US
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Telephone | 603-668-3509
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Fax | 603-641-8442
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | ELLEN YUSE
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Credential |
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Telephone | 603-668-3509
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number |
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License Number State |
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