=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922078153
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SAMUEL C ALDRIDGE MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/23/2006
-----------------------------------------------------
Last Update Date | 07/17/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 246 PLEASANT ST. MEMORIAL BUILDING, WEST, GROUND FLOOR
-----------------------------------------------------
City | CONCORD
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03301-2548
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-415-6400
-----------------------------------------------------
Fax | 603-227-7595
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 246 PLEASANT ST. MEMORIAL BUILDING, WEST, GROUND FLOOR
-----------------------------------------------------
City | CONCORD
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03301-2548
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-415-6400
-----------------------------------------------------
Fax | 603-227-7595
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2086S0129X
-----------------------------------------------------
Taxonomy Name | Vascular Surgery Physician
-----------------------------------------------------
License Number | 9295
-----------------------------------------------------
License Number State | NH
-----------------------------------------------------