Basic Information
| Provider Information | |||||||||
| NPI: | 1851024723 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WENTWORTH DOUGLASS HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 412504 | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 022412504 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 67 CORPORATE DR | ||||||||
| Address2: | |||||||||
| City: | PORTSMOUTH | ||||||||
| State: | NH | ||||||||
| PostalCode: | 038012847 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6037422163 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2022 | ||||||||
| LastUpdateDate: | 07/07/2022 | ||||||||
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| AuthorizedOfficialLastName: | GAGNON | ||||||||
| AuthorizedOfficialFirstName: | TRISHA | ||||||||
| AuthorizedOfficialMiddleName: | LEIGH | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR REVENUE CYCLE OPERATIONS | ||||||||
| AuthorizedOfficialTelephone: | 6037425252 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | WENTWORTH DOUGLASS HOSPITAL | ||||||||
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| NPICertificationDate: | 06/22/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | N | 193400000X SINGLE SPECIALTY GROUP | Dietary & Nutritional Service Providers | Dietitian, Registered | 282N00000X | Y | Hospitals | General Acute Care Hospital |
No ID Information.