1831183268 NPI number — CONCORD OPHTHALMOLOGIC ASSOCIATES PA

Table of content: (NPI 1831183268)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831183268 NPI number — CONCORD OPHTHALMOLOGIC ASSOCIATES PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CONCORD OPHTHALMOLOGIC ASSOCIATES PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1831183268
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/07/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2 PILLSBURY ST STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CONCORD
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03301-3502
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-228-1104
Provider Business Mailing Address Fax Number:
603-228-7061

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2 PILLSBURY ST STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CONCORD
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-228-1104
Provider Business Practice Location Address Fax Number:
603-228-7061
Provider Enumeration Date:
08/31/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
VEINER
Authorized Official First Name:
STEPHEN
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMIN
Authorized Official Telephone Number:
603-224-2020

Provider Taxonomy Codes

  • Taxonomy code: 332H00000X , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207W00000X , 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: 2184123 . This is a "ANTHEM NH" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 82184123 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: CC8278 . This is a "RR MEDICARE EDI GROUP #" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 441183292 . This is a "RR MEDICARE GROUP" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".