Organization
ELLIOT PHYSICIANS NETWORK
Active
Organization
ELLIOT PHYSICIANS NETWORK
Active
Parent organization
ELLIOT PHYSICIANS NETWORK
Other names
Derryfield Medical Group
Organization subpart
Yes
Provider details
NPI number
Legal business name
ELLIOT PHYSICIANS NETWORK
Authorized official
RICHARD P. HERMAN (DIRECTOR OF OPERATIONS & FINANCE)
(603) 663-5766
Entity
Organization
Contact information
Practice address
275 MAMMOTH RD STE 4, DERRYFIELD MEDICAL GROUP, MANCHESTER, NH 03109-4133
(603) 624-4380
(603) 624-4805
Mailing address
275 MAMMOTH RD STE 4, DERRYFIELD MEDICAL GROUP, MANCHESTER, NH 03109-4133
(603) 624-4380
(603) 624-4805
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30210576
—
NH
01
—
CG2227
RR MEDICARE GROUP #
NH
Enumeration date
09/15/2005
Last updated
06/20/2008
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