Facts
- Status
- A
- Credential
- PA-C
- Type
- Individual
- Enumeration date
- 2017-05-19
- Last updated
- 2019-01-16
Licenses
- License VT
- 0550031341
- License NH
- 1321
Location
- Practice location
- 250 PLEASANT ST
- City
- CONCORD NH
- Postal code
- 033017539
- Phone
- 603-225-2711
Medicare
- PECOS
- A PECOS enrollment row matches this NPI.
LEIE
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Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.