=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851722417
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CLEARCHOICEMD, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/09/2013
-----------------------------------------------------
Last Update Date | 10/07/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 798 ROUTE 302
-----------------------------------------------------
City | BERLIN
-----------------------------------------------------
State | VT
-----------------------------------------------------
Zip | 05641-2305
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 802-744-0138
-----------------------------------------------------
Fax | 802-622-0836
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10 FERRY ST STE 302
-----------------------------------------------------
City | CONCORD
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03301-5081
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-526-4635
-----------------------------------------------------
Fax | 603-526-8283
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF EXECUTIVE OFFICER
-----------------------------------------------------
Name | DR. MARCUS J HAMPERS
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 603-526-4635
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QU0200X
-----------------------------------------------------
Taxonomy Name | Urgent Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------