Organization
CATHOLIC MEDICAL CENTER
Active
Organization
CATHOLIC MEDICAL CENTER
Active
Other names
GRANITE STATE INTERNAL MEDICINE
Organization subpart
No
Provider details
NPI number
Authorized official
ANDRE THERRIEN (CONTROLLER)
(603) 663-8779
Entity
Organization
Contact information
Practice address
53 GOFFSTOWN RD, MANCHESTER, NH 03102-2737
(603) 206-1380
(603) 206-1378
Mailing address
53 GOFFSTOWN RD, MANCHESTER, NH 03102-2737
(603) 206-1380
(603) 206-1378
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
30D0998864
CLIA
NH
Enumeration date
03/27/2008
Last updated
10/20/2020
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