Organization
REVERFRONT MEDICAL GROUP, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN MARIE HARE M.D. (OWNER)
(603) 286-3800
Entity
Organization
Contact information
Practice address
322 W MAIN ST, SUITE 133, TILTON, NH 03276-5017
(603) 286-3800
Mailing address
322 W MAIN ST, SUITE 133, TILTON, NH 03276-5017
(603) 286-3800
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
0185862302
NH
174400000X
Specialist
10967
NH
174400000X
Specialist
Primary
11415
NH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30214683
—
NH
Enumeration date
04/17/2007
Last updated
07/30/2008
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