Provider Demographics
NPI:1063694107
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:603-434-1919
Mailing Address - Street 1:40 BUTTRICK RD
Mailing Address - Street 2:ELLIOT INTERNAL MEDICINE AT LONDONDERRY
Mailing Address - City:LONDONDERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03053-3381
Mailing Address - Country:US
Mailing Address - Phone:603-434-1919
Mailing Address - Fax:603-434-7346
Practice Address - Street 1:40 BUTTRICK RD
Practice Address - Street 2:ELLIOT INTERNAL MEDICINE AT LONDONDERRY
Practice Address - City:LONDONDERRY
Practice Address - State:NH
Practice Address - Zip Code:03053-3381
Practice Address - Country:US
Practice Address - Phone:603-434-1919
Practice Address - Fax:603-434-7346
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELLIOT PHYSICIANS NETWORK
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-30
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
NH30216283Medicaid
NHCG2227OtherRR MEDICARE
NHRE5600Medicare PIN