Basic Information
| Provider Information | |||||||||
| NPI: | 1750487682 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PEDERSEN | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 PILLSBURY ST | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | CONCORD | ||||||||
| State: | NH | ||||||||
| PostalCode: | 033013556 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6032244776 | ||||||||
| FaxNumber: | 6032282113 | ||||||||
| Practice Location | |||||||||
| Address1: | 501 SOUTH ST | ||||||||
| Address2: | BOX 2 | ||||||||
| City: | BOW | ||||||||
| State: | NH | ||||||||
| PostalCode: | 033043416 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6032244776 | ||||||||
| FaxNumber: | 6032282113 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/16/2006 | ||||||||
| LastUpdateDate: | 04/23/2009 | ||||||||
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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 | 207L00000X | 12352 | NH | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 30204821 | 05 | NH | MEDICAID | 2250191 | 01 | NH | CIGNA | OTHER | 01Y007282NH01 | 01 | NH | ANTHEM BCBS | OTHER |