Organization
ELLIOT PROFESSIONAL SERVICES
Active
Parent organization
ELLIOT PROFESSIONAL SERVICES
Other names
Elliot Breast Health Center
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
275 MAMMOTH RD STE 1, ELLIOT BREAST HEALTH CENTER, MANCHESTER, NH 03109-4133
(603) 668-3067
(603) 668-0164
Mailing address
275 MAMMOTH RD STE 1, ELLIOT BREAST HEALTH CENTER, MANCHESTER, NH 03109-4133
(603) 668-3067
(603) 668-0164
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30212132
—
NH
01
—
CK3360
RR MEDICARE GRP PIN
NH
Enumeration date
02/23/2006
Last updated
06/20/2008
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