Provider Demographics
NPI:1699763656
Name:RIOS, AGUSTIN E (DPM)
Entity type:Individual
Prefix:
First Name:AGUSTIN
Middle Name:E
Last Name:RIOS
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?:No
Enumeration Date:2005-10-12
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0271213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH40003762Medicaid
NHU56921Medicare UPIN
NH40003762Medicaid