Organization
ELLIOT PROFESSIONAL SERVICES
Active
Parent organization
ELLIOT PROFESSIONAL SERVICES
Other names
Elliot General Surgical Specialists
Organization subpart
Yes
Provider details
NPI number
Legal business name
ELLIOT PROFESSIONAL SERVICES
Authorized official
RICHARD P HERMAN (DIRECTOR OF OPERATIONS/FINANCE)
(603) 663-4904
Entity
Organization
Contact information
Practice address
185 QUEEN CITY AVE, ELLIOT GENERAL SURGICAL SPECIALISTS, MANCHESTER, NH 03101-7100
(603) 627-1102
(603) 647-5524
Mailing address
185 QUEEN CITY AVE, ELLIOT GENERAL SURGICAL SPECIALISTS, MANCHESTER, NH 03101-7100
(603) 627-1102
(603) 647-5524
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
2086S0129X
Vascular Surgery Physician
—
—
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30216408
—
NH
01
—
CK3360
RR MEDICARE
NH
Enumeration date
02/05/2008
Last updated
03/18/2011
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