Provider Demographics
NPI:1053580845
Name:ELLIOT PHYSICIANS NETWORK
Entity type:Organization
Organization Name:ELLIOT PHYSICIANS NETWORK
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS & FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:P
Authorized Official - Last Name:HERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-663-4904
Mailing Address - Street 1:4 ELLIOT WAY STE 102
Mailing Address - Street 2:ELLIOT BAY MEDICAL ASSOCIATES
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03103-3551
Mailing Address - Country:US
Mailing Address - Phone:603-626-5900
Mailing Address - Fax:603-625-2180
Practice Address - Street 1:4 ELLIOT WAY STE 102
Practice Address - Street 2:ELLIOT BAY MEDICAL ASSOCIATES
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03103-3551
Practice Address - Country:US
Practice Address - Phone:603-626-5900
Practice Address - Fax:603-625-2180
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELLIOT PHYSICIANS NETWORK
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-26
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30216443Medicaid
NHCG2227OtherRR MEDICARE
NH30216443Medicaid