Organization
ELLIOT PROFESSIONAL SERVICES
Active
Parent organization
ELLIOT PROFESSIONAL SERVICES
Other names
Wound Management Center
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
185 QUEEN CITY AVE, WOUND MANAGEMENT CENTER, MANCHESTER, NH 03101-7100
(603) 663-3630
(603) 663-3669
Mailing address
185 QUEEN CITY AVE, WOUND MANAGEMENT CENTER, MANCHESTER, NH 03101-7100
(603) 663-3630
(603) 663-3669
Taxonomy
Speciality
Code
Description
License number
State
207PE0005X
Undersea and Hyperbaric Medicine (Emergency Medicine) Physician
—
NH
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30212489
—
NH
01
—
CK3360
RR MEDICARE
NH
Enumeration date
04/04/2006
Last updated
03/18/2011
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