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General NPI Number Information
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NPI Number | 1700889169
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Entity Type | Individual
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Provider Name | BEVERLY J ENTWISLE M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/31/2005
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Last Update Date | 10/24/2007
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Provider Practice Location Address
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Address Line | 250 PLEASANT STREET YEAPLE BUILDING
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City | CONCORD
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State | NH
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Zip | 03301
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Country | US
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Telephone | 603-228-7200
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Fax | 603-228-7307
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Provider Business Mailing Address
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Address Line | 250 PLEASANT STREET YEAPLE BUILDING
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City | CONCORD
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State | NH
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Zip | 03301
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Country | US
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Telephone | 603-228-7200
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Fax | 603-228-7307
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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 | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number | 7945
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License Number State | NH
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