Provider Demographics
NPI:1285728584
Name:SCHIAVONI, EDMUND S JR (MD)
Entity type:Individual
Prefix:DR
First Name:EDMUND
Middle Name:S
Last Name:SCHIAVONI
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:6 TSIENNETO ROAD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:DERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03038-0038
Mailing Address - Country:US
Mailing Address - Phone:603-216-0400
Mailing Address - Fax:603-216-3800
Practice Address - Street 1:6 TSIENNETO ROAD
Practice Address - Street 2:SUITE 300
Practice Address - City:DERRY
Practice Address - State:NH
Practice Address - Zip Code:03038-0038
Practice Address - Country:US
Practice Address - Phone:603-216-0400
Practice Address - Fax:603-216-3800
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2008-10-30
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Provider Licenses
StateLicense IDTaxonomies
NH8939207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30007797Medicaid
NH30007797Medicaid
NHMX8414Medicare PIN