Provider Demographics
NPI:1316996614
Name:FLANNERY, JOHN VINCENT JR (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:VINCENT
Last Name:FLANNERY
Suffix:JR
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 1:8 PROSPECT ST., NORTH II
Mailing Address - Street 2:8 COLON AND RECTAL SURGERY OF NEW ENGLAND
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03060-2949
Mailing Address - Country:US
Mailing Address - Phone:603-577-3322
Mailing Address - Fax:603-577-3376
Practice Address - Street 1:8 PROSPECT ST
Practice Address - Street 2:NORTH II
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060-3925
Practice Address - Country:US
Practice Address - Phone:603-577-3322
Practice Address - Fax:603-577-3376
Is Sole Proprietor?:No
Enumeration Date:2006-05-06
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH15918208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA680149936AMedicaid
GA680149936AMedicaid
GA28BBBDFMedicare PIN