1942214457 NPI number — GRANITE STATE GASTROINTESTINAL CONSULTANTS PLLC

Table of content: MERCEDES DIAZ PEREZ RBT (NPI 1689340937)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942214457 NPI number — GRANITE STATE GASTROINTESTINAL CONSULTANTS PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GRANITE STATE GASTROINTESTINAL CONSULTANTS 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:
1942214457
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/12/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
50 MICHELS WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LONDONDERRY
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03053
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-432-8802
Provider Business Mailing Address Fax Number:
603-437-0118

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
50 MICHELS WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LONDONDERRY
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03053
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-432-8802
Provider Business Practice Location Address Fax Number:
603-437-0118
Provider Enumeration Date:
07/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MCLEAN
Authorized Official First Name:
LEON
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICIAN CO OWNER
Authorized Official Telephone Number:
603-432-8802

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 30002464 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".




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