Basic Information
| Provider Information | |||||||||
| NPI: | 1699724963 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | STERLING HOSPITALIST SERVICE OF NH, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 759414 | ||||||||
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| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212750001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8005141494 | ||||||||
| FaxNumber: | 9048051456 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 PARKLAND DR | ||||||||
| Address2: | |||||||||
| City: | DERRY | ||||||||
| State: | NH | ||||||||
| PostalCode: | 030382746 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6034321500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/06/2006 | ||||||||
| LastUpdateDate: | 04/20/2008 | ||||||||
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| AuthorizedOfficialLastName: | DAUCHERT | ||||||||
| AuthorizedOfficialFirstName: | EUGENE | ||||||||
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| AuthorizedOfficialTitleorPosition: | AUTHORIZED OFFICIAL | ||||||||
| AuthorizedOfficialTelephone: | 9197684392 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 30213907 | 05 | NH | MEDICAID |