=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417251059
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CONCETTA R OTERI-AHMADPOUR
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/22/2010
-----------------------------------------------------
Last Update Date | 12/22/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 31 OLD NASHUA RD UNIT 14
-----------------------------------------------------
City | AMHERST
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03031-2829
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-673-1181
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11 STONE CT
-----------------------------------------------------
City | MILFORD
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03055-3575
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-673-1181
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. CONCETTA R OTERI-AHMADPOUR
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 603-673-1181
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 122549
-----------------------------------------------------
License Number State | NH
-----------------------------------------------------