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NPI Code Detail

MEDICARE: DIANE NUGENT DO

MEDICARE:   DIANE  NUGENT  DO
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
1207Q00000XFamily Medicine Physician16468NH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1578528584
Entity Type Code : Individual
Provider Name (Legal Business Name) : DIANE NUGENT DO
Provider Business Mailing Address
First Line : 789 CENTRAL AVE
Second Line :
City : DOVER
State : NH
Zip : 03820-2526
Country : US
Telephone Number : 603-610-8051
Fax Number :
Provider Business Practice Location Address
First Line : 73 CORPORATE DR
Second Line : SUITE 100
City : PORTSMOUTH
State : NH
Zip : 03801-2847
Country : US
Telephone Number : 603-610-8051
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/20/2006
Last Update Date : 10/28/2016

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Directions to “ DIANE NUGENT DO” Practice Location

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