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Organization

ELLIOT PHYSICIANS NETWORK

Active
Parent organization
ELLIOT PHYSICIANS NETWORK
Other names
Granite State Medical Center
Organization subpart
Yes

Provider details

NPI number
Legal business name
ELLIOT PHYSICIANS NETWORK
Authorized official
RICHARD P. HERMAN (DIRECTOR OF OPERATIONS & FINANCE)
(603) 663-4904
Entity
Organization

Contact information

Practice address
190 TARRYTOWN RD, GRANITE STATE MEDICAL CENTER, MANCHESTER, NH 03103-2713
(603) 626-5113
(603) 622-5298
Mailing address
190 TARRYTOWN RD, GRANITE STATE MEDICAL CENTER, MANCHESTER, NH 03103-2713
(603) 626-5113
(603) 622-5298

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
30210580
NH
01
CG2227
RR MEDICARE GROUP #
NH
Enumeration date
10/31/2005
Last updated
06/20/2008
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