Provider Demographics
NPI:1417706482
Name:VAN LOAN MEDICAL LLC
Entity type:Organization
Organization Name:VAN LOAN MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANNEKE
Authorized Official - Middle Name:L
Authorized Official - Last Name:MCSTOWE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-738-4468
Mailing Address - Street 1:62 BLANFORD PL
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110-4611
Mailing Address - Country:US
Mailing Address - Phone:603-738-4468
Mailing Address - Fax:603-488-1781
Practice Address - Street 1:316 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-3468
Practice Address - Country:US
Practice Address - Phone:603-738-4468
Practice Address - Fax:603-488-1781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-14
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083A0300XAllopathic & Osteopathic PhysiciansPreventive MedicineAddiction MedicineGroup - Single Specialty