| |
1 Granite Pl Ste 200n Concord NH 03301-3271 | |
(603) 226-8686 | |
Not Available |
Full Name | |
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Speciality | Clinic/Center |
Location | 1 Granite Pl Ste 200n, Concord, New Hampshire |
Authorized Official Name and Position | Charles Fanaras (DIRECTOR) |
Authorized Official Contact | 6032268686 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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1 Granite Pl Ste 200n Concord NH 03301-3271 Ph: () - | 1 Granite Pl Ste 200n Concord NH 03301-3271 Ph: (603) 226-8686 |
NPI Number | 1316638521 |
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Provider Enumeration Date | 05/18/2023 |
Last Update Date | 05/22/2023 |
Medicare PECOS PAC ID | 3173987609 |
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Medicare Enrollment ID | O20230915002048 |
Identifier | Type | State | Issuer |
---|---|---|---|
1316638521 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
261QH0100X | Clinic/center - Health Service | (* (Not Available)) | Primary |
Provider Name | Marie Jane Germono Lord |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1023485307 PECOS PAC ID: 0143539262 Enrollment ID: I20170127001228 |
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