1659488757 NPI number — GUEORGUI D DIMOV MD

Table of content: GUEORGUI D DIMOV MD (NPI 1659488757)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659488757 NPI number — GUEORGUI D DIMOV MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DIMOV
Provider First Name:
GUEORGUI
Provider Middle Name:
D
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:
1659488757
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/03/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 655
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EXETER
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03833-0655
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-775-0000
Provider Business Mailing Address Fax Number:
603-775-0247

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6 HAMPTON RD
Provider Second Line Business Practice Location Address:
BLDG 3
Provider Business Practice Location Address City Name:
EXETER
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03833-4854
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-775-0000
Provider Business Practice Location Address Fax Number:
603-775-0247
Provider Enumeration Date:
08/24/2006

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: 207Q00000X , with the licence number:  EC05064 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: 13621 , 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: 30207038 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: NONE . This is a "RESIDENT-NO PROV #" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".




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