Basic Information
Provider Information | |||||||||
NPI: | 1861451239 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | CHIBARO | ||||||||
FirstName: | EDWARD | ||||||||
MiddleName: | A | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 44 BIRCH ST | ||||||||
Address2: |   | ||||||||
City: | DERRY | ||||||||
State: | NH | ||||||||
PostalCode: | 030382752 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6034346380 | ||||||||
FaxNumber: | 6034343626 | ||||||||
Practice Location | |||||||||
Address1: | 44 BIRCH ST | ||||||||
Address2: |   | ||||||||
City: | DERRY | ||||||||
State: | NH | ||||||||
PostalCode: | 030382752 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6034346380 | ||||||||
FaxNumber: | 6034343626 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 03/22/2006 | ||||||||
LastUpdateDate: | 03/04/2014 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | NH6724 | NH | Y |   | Allopathic & Osteopathic Physicians | Urology |   |
ID Information
ID | Type | State | Issuer | Description | 4146695 | 01 | NH | MVP HEALTHCARE | OTHER | 0104597Y0NH02 | 01 | NH | ANTHEM BCBS | OTHER | 93989 | 01 | NH | AETNA | OTHER | NH0991 | 01 | MA | BLUE CROSS BLUE SHIELD | OTHER | 81340991 | 05 | NH |   | MEDICAID | B85951 | 01 | NH | HARVARD PILGRIM | OTHER | 006724 | 01 | NH | TUFTS HEALTH PLAN | OTHER | 1904021 | 01 | NH | UNITED HEALTHCARE | OTHER | 5150 | 01 | NH | HEALTHSOURCE | OTHER |