Organization
ELLIOT PHYSICIANS NETWORK
Active
Parent organization
ELLIOT PHYSICIANS NETWORK
Other names
Elliot Family Medicine at Glen Lake
Organization subpart
Yes
Provider details
NPI number
Legal business name
ELLIOT PHYSICIANS NETWORK
Authorized official
RICHARD P. HERMAN (DIRECTOR OF OPERATIONS & FINANCE)
(603) 663-4904
Entity
Organization
Contact information
Practice address
89 S MAST RD, ELLIOT FAMILY MEDICINE AT GLEN LAKE, GOFFSTOWN, NH 03045-6102
(603) 497-5661
(603) 497-5740
Mailing address
89 S MAST RD, ELLIOT FAMILY MEDICINE AT GLEN LAKE, GOFFSTOWN, NH 03045-6102
(603) 497-5661
(603) 497-5740
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30211110
—
NH
01
—
CG2227
RR MEDICARE GROUP
—
Enumeration date
10/31/2005
Last updated
06/20/2008
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