Organization
ELLIOT PROFESSIONAL SERVICES
Active
Parent organization
ELLIOT PROFESSIONAL SERVICES
Other names
Elliot Pediatric Surgery Associates
Organization subpart
Yes
Provider details
NPI number
Legal business name
ELLIOT PROFESSIONAL SERVICES
Authorized official
RICHARD P. HERMAN (DIRECTOR OF OPERATIONS & FINANCE)
(603) 663-4904
Entity
Organization
Contact information
Practice address
275 MAMMOTH RD STE 1, ELLIOT PEDIATRIC SURGERY ASSOCIATES, MANCHESTER, NH 03109-4133
(603) 663-8373
(603) 663-8399
Mailing address
275 MAMMOTH RD STE 1, ELLIOT PEDIATRIC SURGERY ASSOCIATES, MANCHESTER, NH 03109-4133
(603) 663-8373
(603) 663-8399
Taxonomy
Speciality
Code
Description
License number
State
2086S0120X
Pediatric Surgery Physician
Primary
—
NH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30214278
—
NH
01
—
CK3360
RR MEDICARE
NH
Enumeration date
05/17/2006
Last updated
06/20/2008
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