Basic Information
| Provider Information | |||||||||
| NPI: | 1649226358 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ENDOCRINOLOGY & DIABETES CONSULTANTS, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 19 WEBB PL | ||||||||
| Address2: | |||||||||
| City: | DOVER | ||||||||
| State: | NH | ||||||||
| PostalCode: | 038202403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6037421143 | ||||||||
| FaxNumber: | 6037493509 | ||||||||
| Practice Location | |||||||||
| Address1: | 19 WEBB PL | ||||||||
| Address2: | |||||||||
| City: | DOVER | ||||||||
| State: | NH | ||||||||
| PostalCode: | 038202403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6037421143 | ||||||||
| FaxNumber: | 6037493509 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/25/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | TUNG | ||||||||
| AuthorizedOfficialFirstName: | PAUL | ||||||||
| AuthorizedOfficialMiddleName: | C. | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6037421143 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RE0101X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism |
ID Information
| ID | Type | State | Issuer | Description | 99004014 | 05 | NH | MEDICAID |