1235197153 NPI number — GEOFFREY W SHRECK M.D.

Table of content: GEOFFREY W SHRECK M.D. (NPI 1235197153)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235197153 NPI number — GEOFFREY W SHRECK M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHRECK
Provider First Name:
GEOFFREY
Provider Middle Name:
W
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235197153
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/28/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 HAMPTON RD
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
EXETER
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03833-4848
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-778-0708
Provider Business Mailing Address Fax Number:
603-775-7177

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 HAMPTON RD
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
EXETER
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03833-4848
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-778-0708
Provider Business Practice Location Address Fax Number:
603-775-7177
Provider Enumeration Date:
05/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  158549 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 1278 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com