Provider Demographics
NPI:1962611343
Name:GRANITE STATE INTERNAL MEDICINE
Entity type:Organization
Organization Name:GRANITE STATE INTERNAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:J
Authorized Official - Last Name:FINOCCHIARO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-206-1380
Mailing Address - Street 1:53 GOFFSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03102-2737
Mailing Address - Country:US
Mailing Address - Phone:603-206-1380
Mailing Address - Fax:
Practice Address - Street 1:53 GOFFSTOWN RD
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03102-2737
Practice Address - Country:US
Practice Address - Phone:603-206-1380
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHRE6463Medicare ID - Type Unspecified