Individual
DR. CHANDLER W MARIETTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
85 SPRING STREET, ENT ASSOCIATES OF NEW HAMPSHIRE, LACONIA, NH 03246-3113
(603) 524-7402
(603) 524-0945
Mailing address
85 SPRING ST, LACONIA, NH 03246-3113
(603) 524-7402
(603) 524-0945
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
104228
MN
207Y00000X
Otolaryngology Physician
Primary
15543
NH
207Y00000X
Otolaryngology Physician
T0557
NH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
15543
LICENSE
NH
05
—
3077638
—
NH
Enumeration date
07/31/2006
Last updated
08/31/2020
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