Provider Demographics
NPI:1992798482
Name:BJERKE, HENRY SCOTT (MD)
Entity type:Individual
Prefix:DR
First Name:HENRY
Middle Name:SCOTT
Last Name:BJERKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 PERRY RD
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110-4525
Mailing Address - Country:US
Mailing Address - Phone:603-714-9685
Mailing Address - Fax:
Practice Address - Street 1:1 ELLIOT WAY
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03103
Practice Address - Country:US
Practice Address - Phone:603-627-1102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2018-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01051130A208600000X, 2086S0102X, 2086S0127X
MI4301115212208600000X
MO20090185722086S0127X
NH180552086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200627450 AMedicaid
IN200246310BMedicaid
MO1992798482Medicaid
KS200627450 AMedicaid
MOT41000005Medicare PIN
IN200246310BMedicaid
IN180150Medicare PIN