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190 Tarrytown Rd Granite State Medical Center Manchester NH 03103-2713 | |
(603) 626-5113 | |
(603) 622-5298 |
Full Name | |
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Speciality | Internal Medicine |
Location | 190 Tarrytown Rd, Manchester, New Hampshire |
Authorized Official Name and Position | Richard P. Herman (DIRECTOR OF OPERATIONS & FINANCE) |
Authorized Official Contact | 6036634904 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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190 Tarrytown Rd Granite State Medical Center Manchester NH 03103-2713 Ph: (603) 626-5113 | 190 Tarrytown Rd Granite State Medical Center Manchester NH 03103-2713 Ph: (603) 626-5113 |
NPI Number | 1063403996 |
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Provider Enumeration Date | 10/31/2005 |
Last Update Date | 06/20/2008 |
Identifier | Type | State | Issuer |
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1063403996 | NPI | - | NPPES |
CG2227 | Other | NH | RR MEDICARE GROUP # |
30210580 | Medicaid | NH |
Taxonomy | Type | License (State) | Status |
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207R00000X | Internal Medicine | (* (Not Available)) | Primary |
Healthways Family Practice Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 59 Sheffield Rd, Manchester, NH 03103 Phone: 603-606-7020 Fax: 603-622-4102 |