Provider Demographics
NPI:1407416043
Name:MEDREK, ROBERT J (ND)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
Last Name:MEDREK
Suffix:
Gender:M
Credentials:ND
Other - Prefix:DR
Other - First Name:ROBERT
Other - Middle Name:J
Other - Last Name:MEDREK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ND
Mailing Address - Street 1:44 BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-3902
Mailing Address - Country:US
Mailing Address - Phone:603-430-7600
Mailing Address - Fax:603-430-9020
Practice Address - Street 1:44 BRIDGE ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-3902
Practice Address - Country:US
Practice Address - Phone:603-430-7600
Practice Address - Fax:603-430-9020
Is Sole Proprietor?:No
Enumeration Date:2019-06-17
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH78175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath