Basic Information
| Provider Information | |||||||||
| NPI: | 1770553745 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CLIFFORD | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | H | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1327 | ||||||||
| Address2: | |||||||||
| City: | LACONIA | ||||||||
| State: | NH | ||||||||
| PostalCode: | 032471327 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6035243211 | ||||||||
| FaxNumber: | 6035277038 | ||||||||
| Practice Location | |||||||||
| Address1: | 85 SPRING ST | ||||||||
| Address2: | |||||||||
| City: | LACONIA | ||||||||
| State: | NH | ||||||||
| PostalCode: | 032463113 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6035277114 | ||||||||
| FaxNumber: | 6035272945 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 207Q00000X | 7501 | NH | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 3412770 | 01 | NH | AETNA | OTHER | 383799 | 01 | NH | MVP | OTHER | 2266103 | 01 | NH | CIGNA | OTHER | NH2284 | 01 | NH | HARVARD PILGRIM HLTHCARE | OTHER | 30009494 | 05 | NH | MEDICAID |