Basic Information
| Provider Information | |||||||||
| NPI: | 1518176387 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GATES | ||||||||
| FirstName: | ELISE | ||||||||
| MiddleName: | KATHLEEN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 185 QUEEN CITY AVE | ||||||||
| Address2: | |||||||||
| City: | MANCHESTER | ||||||||
| State: | NH | ||||||||
| PostalCode: | 031017121 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6036683067 | ||||||||
| FaxNumber: | 6036680164 | ||||||||
| Practice Location | |||||||||
| Address1: | 185 QUEEN CITY AVE | ||||||||
| Address2: | |||||||||
| City: | MANCHESTER | ||||||||
| State: | NH | ||||||||
| PostalCode: | 03101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6036683067 | ||||||||
| FaxNumber: | 6036680164 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/21/2007 | ||||||||
| LastUpdateDate: | 12/20/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 052083 | CT | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | 251362 | MA | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | 19124 | NH | Y | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.