MEDICARE: CONVENIENTMD LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QI0500X	Infusion Therapy Clinic/Center

General Provider Information

NPI Number	:	1386281020
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONVENIENTMD LLC

Provider Business Mailing Address
First Line	:	111 NEW HAMPSHIRE AVE
Second Line	:
City	:	PORTSMOUTH
State	:	NH
Zip	:	03801-2864
Country	:	US
Telephone Number	:	603-410-6700
Fax Number	:

Provider Business Practice Location Address
First Line	:	479 WASHINGTON ST
Second Line	:
City	:	QUINCY
State	:	MA
Zip	:	02169-5895
Country	:	US
Telephone Number	:	857-529-5220
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE CHAIRMAN
Name	:	GARETH DICKENS
Credential	:
Telephone Number	:	603-501-0863

Provider Enumeration Date	:	12/02/2019
Last Update Date	:	12/02/2019

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