Basic Information
| Provider Information | |||||||||
| NPI: | 1447364567 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FRIESE | ||||||||
| FirstName: | STEVEN | ||||||||
| MiddleName: | B. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 590 COURT ST | ||||||||
| Address2: | DARTMOUTH HITCHCOCK - EMERGENCY MEDICINE | ||||||||
| City: | KEENE | ||||||||
| State: | NH | ||||||||
| PostalCode: | 034311719 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6033546534 | ||||||||
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| Practice Location | |||||||||
| Address1: | 590 COURT ST | ||||||||
| Address2: | DARTMOUTH HITCHCOCK - EMERGENCY MEDICINE | ||||||||
| City: | KEENE | ||||||||
| State: | NH | ||||||||
| PostalCode: | 034311719 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6033546534 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/18/2006 | ||||||||
| LastUpdateDate: | 01/19/2017 | ||||||||
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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 | MD-13904 | HI | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 16476 | NH | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0000262527 | 01 | HI | HMSA BILLING NUMBER | OTHER | 585987-03 | 05 | HI | MEDICAID |