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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