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Organization

ELLIOT PROFESSIONAL SERVICES

Active
Parent organization
ELLIOT PROFESSIONAL SERVICES
Other names
ELLIOT GASTROENTEROLOGY
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, ELLIOT GASTROENTEROLOGY, MANCHESTER, NH 03101-7100
(603) 314-6900
(603) 314-6909
Mailing address
185 QUEEN CITY AVE, ELLIOT GASTROENTEROLOGY, MANCHESTER, NH 03101-7100
(603) 314-6900
(603) 314-6909

Taxonomy

Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
RE6661
MEDICARE GROUP
NH
Enumeration date
08/18/2010
Last updated
04/01/2011
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