Provider Demographics
NPI:1538157581
Name:DANANBERG, HOWARD J (DPM)
Entity type:Individual
Prefix:
First Name:HOWARD
Middle Name:J
Last Name:DANANBERG
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 EASTMAN AVE
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110-6701
Mailing Address - Country:US
Mailing Address - Phone:603-625-5772
Mailing Address - Fax:603-625-9889
Practice Address - Street 1:21 EASTMAN AVE
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110-6701
Practice Address - Country:US
Practice Address - Phone:603-625-5772
Practice Address - Fax:603-625-9889
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-12
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0124213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHRE2092Medicare ID - Type Unspecified
NHT25723Medicare UPIN