Basic Information
| Provider Information | |||||||||
| NPI: | 1174532659 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JOSEPHS | ||||||||
| FirstName: | MARK | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 74 PLEASANT ST | ||||||||
| Address2: | STE 204 | ||||||||
| City: | NEW LONDON | ||||||||
| State: | NH | ||||||||
| PostalCode: | 032575881 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6039260088 | ||||||||
| FaxNumber: | 6039262853 | ||||||||
| Practice Location | |||||||||
| Address1: | 5 ALUMNI DR | ||||||||
| Address2: | |||||||||
| City: | EXETER | ||||||||
| State: | NH | ||||||||
| PostalCode: | 038332128 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6035806793 | ||||||||
| FaxNumber: | 6035807006 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/05/2006 | ||||||||
| LastUpdateDate: | 01/10/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 5767 | NH | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 311400099 | 05 | ME | MEDICAID | 930100691 | 01 | RAILROAD MEDICARE | OTHER | 30201083 | 05 | NH | MEDICAID | 0108875Y0NH01 | 01 | NH | ANTHEM | OTHER | 0112861 | 05 | MA | MEDICAID | AA14881 | 01 | HARVARD PILGRIM | OTHER |