=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407297096
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JASON LIM M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/11/2013
-----------------------------------------------------
Last Update Date | 07/11/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 250 PLEASANT ST CHFHC, YEAPLE BUILDING
-----------------------------------------------------
City | CONCORD
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03301-7539
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-225-7200
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 59 S MAIN ST UNIT 2, SECOND FLOOR
-----------------------------------------------------
City | CONCORD
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03301-4848
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 202-679-7557
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
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 | RT-2541
-----------------------------------------------------
License Number State | NH
-----------------------------------------------------