Basic Information
| Provider Information | |||||||||
| NPI: | 1063083822 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CONVENEINTMD LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 111 NH AVE | ||||||||
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| City: | PORTSMOUTH | ||||||||
| State: | NH | ||||||||
| PostalCode: | 038012864 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6034106700 | ||||||||
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| Practice Location | |||||||||
| Address1: | 351 WINCHESTER ST | ||||||||
| Address2: | |||||||||
| City: | KEENE | ||||||||
| State: | NH | ||||||||
| PostalCode: | 034313930 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6033523406 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/02/2021 | ||||||||
| LastUpdateDate: | 07/02/2021 | ||||||||
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| AuthorizedOfficialLastName: | BOISSONNEAULT | ||||||||
| AuthorizedOfficialFirstName: | JAROD | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR OF REVENUE CYCLE MGT | ||||||||
| AuthorizedOfficialTelephone: | 6033196223 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 07/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.