Basic Information
| Provider Information | |||||||||
| NPI: | 1548229917 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UROLOGICAL SURGERY P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2200 | ||||||||
| Address2: | |||||||||
| City: | AMHERST | ||||||||
| State: | NH | ||||||||
| PostalCode: | 030314200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6036739411 | ||||||||
| FaxNumber: | 6036739899 | ||||||||
| Practice Location | |||||||||
| Address1: | 44 BIRCH ST | ||||||||
| Address2: | SUITE 303 | ||||||||
| City: | DERRY | ||||||||
| State: | NH | ||||||||
| PostalCode: | 030382752 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6034346380 | ||||||||
| FaxNumber: | 6034343626 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/22/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | CHIBARO | ||||||||
| AuthorizedOfficialFirstName: | EDWARD | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6034346380 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Urology |
ID Information
| ID | Type | State | Issuer | Description | 30003201 | 05 | NH | MEDICAID | NH9371 | 01 | MA | BLUE CROSS BLUE SHIELD | OTHER | 515 | 01 | NH | HEALTHSOURCE | OTHER | 708360 | 01 | NH | TUFTS HEALTH PLAN | OTHER |