Basic Information
Provider Information | |||||||||
NPI: | 1528210010 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | GUIDANCE MEDICAL ASSOCIATES, P.C. | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 677 | ||||||||
Address2: |   | ||||||||
City: | LACONIA | ||||||||
State: | NH | ||||||||
PostalCode: | 032472239 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6035270052 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 25 COUNTRY CLUB ROAD | ||||||||
Address2: | UNIT 702 | ||||||||
City: | GILFORD | ||||||||
State: | NH | ||||||||
PostalCode: | 032492812 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6035270052 | ||||||||
FaxNumber: | 6033696365 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/16/2008 | ||||||||
LastUpdateDate: | 12/04/2014 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | MCCARTHY | ||||||||
AuthorizedOfficialFirstName: | GREGORY | ||||||||
AuthorizedOfficialMiddleName: | M. | ||||||||
AuthorizedOfficialTitleorPosition: | SOLE PROPRIETOR, OWNER | ||||||||
AuthorizedOfficialTelephone: | 6035270052 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | M.D. | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 7256 | NH | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |   |
ID Information
ID | Type | State | Issuer | Description | 80002319 | 05 | NH |   | MEDICAID |