Basic Information
| Provider Information | |||||||||
| NPI: | 1568435386 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GUARDIANO | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | ANTHONY | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 51 RAILROAD ST | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | KEENE | ||||||||
| State: | NH | ||||||||
| PostalCode: | 034313987 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6033545454 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 51 RAILROAD ST | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | KEENE | ||||||||
| State: | NH | ||||||||
| PostalCode: | 034313987 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6033545454 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/10/2006 | ||||||||
| LastUpdateDate: | 11/22/2017 | ||||||||
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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 | 207N00000X | 0102831108 | VA | N | Allopathic & Osteopathic Physicians | Dermatology | 207N00000X | 13860 | NH | Y | Allopathic & Osteopathic Physicians | Dermatology |
ID Information
| ID | Type | State | Issuer | Description | 30226765 | 05 | NH | MEDICAID |