Provider Demographics
NPI:1104871052
Name:N.H.GASTROENTEROLOGY,INC
Entity type:Organization
Organization Name:N.H.GASTROENTEROLOGY,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:P
Authorized Official - Last Name:MARCOUX
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:603-625-5744
Mailing Address - Street 1:88 MCGREGOR ST
Mailing Address - Street 2:SUITE 302
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03102-3750
Mailing Address - Country:US
Mailing Address - Phone:603-625-5744
Mailing Address - Fax:603-625-1740
Practice Address - Street 1:88 MCGREGOR ST
Practice Address - Street 2:SUITE 302
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03102-3750
Practice Address - Country:US
Practice Address - Phone:603-625-5744
Practice Address - Fax:603-625-1740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30011541Medicaid
NHRE4963Medicare ID - Type Unspecified