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General NPI Number Information
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NPI Number | 1710133087
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Entity Type | Organization
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Legal Business Name | AESTHETIC MEDICINE OF NH
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Dates
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Enumeration Date | 08/18/2008
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Last Update Date | 08/18/2008
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Provider Practice Location Address
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Address Line | 194 PLEASANT ST SUITE 12
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City | CONCORD
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State | NH
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Zip | 03301-2952
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Country | US
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Telephone | 603-224-0808
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Fax | 603-224-0853
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Provider Business Mailing Address
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Address Line | 194 PLEASANT ST SUITE 12
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City | CONCORD
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State | NH
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Zip | 03301-2952
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Country | US
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Telephone | 603-224-0808
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Fax | 603-224-0853
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Authorized Official
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Title or Position | BUSINESS OWNER
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Name | MR. NICHOLAS PAUL VAN LOAN
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Credential | M.D.
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Telephone | 603-224-0808
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 6630
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License Number State | NH
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