Provider Demographics
NPI:1457359556
Name:BEDFORD COMMONS OB GYN PA
Entity type:Organization
Organization Name:BEDFORD COMMONS OB GYN PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:F
Authorized Official - Last Name:LECLAIR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:605-668-8400
Mailing Address - Street 1:201 RIVERWAY PL
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110-6763
Mailing Address - Country:US
Mailing Address - Phone:603-668-8400
Mailing Address - Fax:603-629-9346
Practice Address - Street 1:201 RIVERWAY PL
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110-6763
Practice Address - Country:US
Practice Address - Phone:603-668-8400
Practice Address - Fax:603-629-9346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-12
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH0326Medicare ID - Type Unspecified