Organization
GRANITE STATE ORTHOTICS AND PROSTHETICS, LLC
Active
Organization
GRANITE STATE ORTHOTICS AND PROSTHETICS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GERARD JOSEPH FOWLER II CO, CPED. (OWNER/PRACTITIONER)
(603) 228-7159
Entity
Organization
Contact information
Practice address
280 PLEASANT ST STE 3, CONCORD, NH 03301-2553
(603) 228-7159
(603) 225-4265
Mailing address
280 PLEASANT ST STE 3, CONCORD, NH 03301-2553
(603) 228-7159
(603) 225-4265
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12Y002242NH01
ANTHEM
NH
01
—
2264576
CIGNA
NH
05
—
30761501
—
NH
01
—
4665514
AETNA
NH
01
—
706167
HARVARD PILGRIM
NH
Enumeration date
12/18/2007
Last updated
04/20/2008
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