Provider Demographics
NPI:1033118104
Name:WENTWORTH DOUGLASS HOSPITAL
Entity type:Organization
Organization Name:WENTWORTH DOUGLASS HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DEGENAARS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-742-5252
Mailing Address - Street 1:PO BOX 412540
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-2540
Mailing Address - Country:US
Mailing Address - Phone:603-740-2400
Mailing Address - Fax:
Practice Address - Street 1:789 CENTRAL AVENUE
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820
Practice Address - Country:US
Practice Address - Phone:603-740-2400
Practice Address - Fax:603-740-2244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-20
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2471M2300X, 261QP2000X, 261QP3300X, 261QR0200X, 261QR0400X, 261QU0200X, 261QX0100X, 2085R0202X, 2085U0001X, 247100000X, 2471B0102X, 261QX0203X, 291U00000X, 282N00000X
NH00010282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes282N00000XHospitalsGeneral Acute Care HospitalGroup - Single Specialty
No2471M2300XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMammographyGroup - Single Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPainGroup - Single Specialty
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiologyGroup - Single Specialty
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitationGroup - Single Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Single Specialty
No261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational MedicineGroup - Single Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Single Specialty
No247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistGroup - Single Specialty
No2471B0102XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistBone DensitometryGroup - Single Specialty
No261QX0203XAmbulatory Health Care FacilitiesClinic/CenterOncology, Radiation
No291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3126778Medicaid
NH3127023Medicaid
NH3074430Medicaid
NH3137697Medicaid