1093736340 NPI number — DR. ROSLINDE MARY COLLINS-GIBBARD MD

Table of content: DR. ROSLINDE MARY COLLINS-GIBBARD MD (NPI 1093736340)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093736340 NPI number — DR. ROSLINDE MARY COLLINS-GIBBARD MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COLLINS-GIBBARD
Provider First Name:
ROSLINDE
Provider Middle Name:
MARY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
COLLINS
Provider Other First Name:
ROSLINDE
Provider Other Middle Name:
MARY
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1093736340
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/26/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
ONE MEDICAL CENTER DR
Provider Second Line Business Mailing Address:
DARTMOUTH HITCHCOCK - CRITICAL CARE MEDICINE
Provider Business Mailing Address City Name:
LEBANON
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03756
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-650-5120
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
ONE MEDICAL CENTER DR
Provider Second Line Business Practice Location Address:
DARTMOUTH HITCHCOCK - CRITICAL CARE MEDICINE
Provider Business Practice Location Address City Name:
LEBANON
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03756
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-650-5120
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/22/2006

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:  17362 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 015629 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0200X , with the licence number: 042-0011270 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RP1001X , with the licence number: 042-0011270 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RS0012X , with the licence number: 042-0011270 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RS0012X , with the licence number: 17362 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0200X , with the licence number: 17362 , 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: 1013328 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3102915 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".