Provider Demographics
NPI:1316234099
Name:DUGAN, SAM (MD)
Entity type:Individual
Prefix:DR
First Name:SAM
Middle Name:
Last Name:DUGAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 SYLVAN LN
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03102-8419
Mailing Address - Country:US
Mailing Address - Phone:603-935-7700
Mailing Address - Fax:603-935-7700
Practice Address - Street 1:360 ROUTE 101
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110-5030
Practice Address - Country:US
Practice Address - Phone:603-471-0831
Practice Address - Fax:603-471-0890
Is Sole Proprietor?:No
Enumeration Date:2011-07-01
Last Update Date:2011-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH4572208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH81374093Medicaid
NHE34497Medicare UPIN