Organization
ELLIOT PHYSICIANS NETWORK
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RICHARD P. HERMAN (DIRECTOR OF OPERATIONS & FINANCE)
(603) 663-4904
Entity
Organization
Contact information
Practice address
1070 HOLT AVENUE, UNIT 1 SUITE 2200, MANCHESTER, NH 03109
(603) 663-4900
(603) 663-4984
Mailing address
1070 HOLT AVE, UNIT 1 SUITE 2200, MANCHESTER, NH 03109-5603
(603) 663-4900
(603) 663-4984
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NH
207R00000X
Internal Medicine Physician
—
NH
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
—
NH
208000000X
Pediatrics Physician
—
NH
261QU0200X
Urgent Care Clinic/Center
03977
NH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CG2227
RR MEDICARE GROUP #
NH
Enumeration date
08/11/2005
Last updated
07/21/2022
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