Provider Demographics
NPI:1992908644
Name:MANCHESTER COMMUNITY HEALTH CENTER
Entity type:Organization
Organization Name:MANCHESTER COMMUNITY HEALTH CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:A
Authorized Official - Last Name:DIBRIGIDA, MD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:603-668-6629
Mailing Address - Street 1:1245 ELM STREET,
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03101
Mailing Address - Country:US
Mailing Address - Phone:602-668-6629
Mailing Address - Fax:603-622-7680
Practice Address - Street 1:145 HOLLIS ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03101-1235
Practice Address - Country:US
Practice Address - Phone:603-668-6629
Practice Address - Fax:603-622-7680
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MANCHESTER COMMUNITY HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-06-08
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH82370079Medicaid