Organization
WENTWORTH DOUGLASS PHYSICIAN CORPORATION
Active
Organization
WENTWORTH DOUGLASS PHYSICIAN CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOEL DEGENAARS (EXECUTIVE DIRECTOR OF FINANCE)
(603) 740-2806
Entity
Organization
Contact information
Practice address
10 MEMBERS WAY FL 5, DOVER, NH 03820-5933
(603) 609-6800
Mailing address
PO BOX 412503, BOSTON, MA 02241-2503
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
—
—
163WD0400X
Diabetes Educator Registered Nurse
Primary
—
—
1835N1003X
Nutrition Support Pharmacist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
004786
ADA CERTIFICATION
NH
Enumeration date
08/18/2020
Last updated
12/17/2025
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