1285662759 NPI number — DOUGLAS M GOUMAS MD

Table of content: DOUGLAS M GOUMAS MD (NPI 1285662759)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285662759 NPI number — DOUGLAS M GOUMAS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GOUMAS
Provider First Name:
DOUGLAS
Provider Middle Name:
M
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:
1285662759
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/15/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17 RIVERSIDE ST
Provider Second Line Business Mailing Address:
STE 101
Provider Business Mailing Address City Name:
NASHUA
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03062-1373
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-883-0091
Provider Business Mailing Address Fax Number:
603-881-3739

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
35 KOSCIUSZKO ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANCHESTER
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03101-1608
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-634-0080
Provider Business Practice Location Address Fax Number:
603-881-3739
Provider Enumeration Date:
06/30/2006

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: 207X00000X , with the licence number:  11057 , 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: 8709923 . This is a "CIGNA PROVIDER #" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 1922164797 . This is a "NPI, PROVIDER LOCATION" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 1841320207 . This is a "NPI, PROVIDER LOCATION" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 01Y002717NH01 . This is a "ANTHEM BC/BS PROVIDER #" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 1881772242 . This is a "NPI, PROVIDER LOCATION" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 1861558645 . This is a "NPI, PROVIDER LOCATION" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 1932256914 . This is a "NPI, PROVIDER LOCATION" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 30201613 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1801952692 . This is a "NPI, PROVIDER LOCATION" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: G94468 . This is a "HARVARD HEALTH PROVIDER #" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".




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