1215927637 NPI number — LOUIS J. NACKMAN MD

Table of content: (NPI 1487667655)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215927637 NPI number — LOUIS J. NACKMAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NACKMAN
Provider First Name:
LOUIS
Provider Middle Name:
J.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1215927637
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/27/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18 ORCHARD VIEW DR
Provider Second Line Business Mailing Address:
ELLIOT PEDIATRICS AT LONDONDERRY
Provider Business Mailing Address City Name:
LONDONDERRY
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03053-6605
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-552-1350
Provider Business Mailing Address Fax Number:
603-552-1359

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
275 MAMMOTH RD
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
MANCHESTER
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03109-4133
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-663-8300
Provider Business Practice Location Address Fax Number:
603-663-8349
Provider Enumeration Date:
10/26/2005

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: 208000000X , with the licence number:  9740 , 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)

  • Identifier: 0107423YPNH01 . This is a "ANTHEM ACES PIN" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 2128 . This is a "CIGNA PIN" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 12-40733 . This is a "UHC PIN" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 30009879 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 845104 . This is a "AETNA PIN" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: HLO004 . This is a "HPHC PIN" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 406452 . This is a "TUFTS PIN" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: G03404 . This is a "ANTHEM REFERRING UPIN" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: P639259 . This is a "OXFORD" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".




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