1851722417 NPI number — CLEARCHOICEMD, PLLC

Table of content: (NPI 1851722417)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851722417 NPI number — CLEARCHOICEMD, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLEARCHOICEMD, PLLC
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:
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:
1851722417
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/07/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10 FERRY ST STE 302
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:
03301-5081
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-526-4635
Provider Business Mailing Address Fax Number:
603-526-8283

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
798 ROUTE 302
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BERLIN
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05641-2305
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-744-0138
Provider Business Practice Location Address Fax Number:
802-622-0836
Provider Enumeration Date:
12/09/2013

Additional Information

Authorized Official

Authorized Official Last Name:
HAMPERS
Authorized Official First Name:
MARCUS
Authorized Official Middle Name:
J
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
603-526-4635

Provider Taxonomy Codes

  • Taxonomy code: 261QU0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1022955 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3126640 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3096072 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3132319 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3126641 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3135935 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3111584 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3114986 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3119431 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3126642 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3133069 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1851722417 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3124083 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".




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