Provider Demographics
NPI:1194754887
Name:CONCORD OTOLARYNGOLOGY HEAD & NECK SURGERY P.A.
Entity type:Organization
Organization Name:CONCORD OTOLARYNGOLOGY HEAD & NECK SURGERY P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:DANIELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:603-224-2353
Mailing Address - Street 1:194 PLEASANT ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-2952
Mailing Address - Country:US
Mailing Address - Phone:603-224-2353
Mailing Address - Fax:
Practice Address - Street 1:194 PLEASANT ST
Practice Address - Street 2:SUITE 2
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-2952
Practice Address - Country:US
Practice Address - Phone:603-224-2353
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH99000906Medicaid
NHNH6814Medicare PIN