=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588867667
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HANOVER CONTINUITY CLINIC, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/07/2007
-----------------------------------------------------
Last Update Date | 11/20/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 45 LYME RD SUITE 104
-----------------------------------------------------
City | HANOVER
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03755-1220
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-643-3320
-----------------------------------------------------
Fax | 603-643-3301
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 45 LYME RD SUITE 104
-----------------------------------------------------
City | HANOVER
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03755-1219
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-643-3320
-----------------------------------------------------
Fax | 603-643-3301
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PARTNER
-----------------------------------------------------
Name | DR. ADAM JULES SCHWARZ
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 603-643-3320
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number | 10169
-----------------------------------------------------
License Number State | NH
-----------------------------------------------------