Basic Information
| Provider Information | |||||||||
| NPI: | 1881602472 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | EBNER | ||||||||
| FirstName: | JOSEPH | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 706 | ||||||||
| Address2: | |||||||||
| City: | PLYMOUTH | ||||||||
| State: | NH | ||||||||
| PostalCode: | 032640706 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6034818757 | ||||||||
| FaxNumber: | 6032382163 | ||||||||
| Practice Location | |||||||||
| Address1: | 16 HOSPITAL ROAD | ||||||||
| Address2: | PLYMOUTH OB/GYN | ||||||||
| City: | PLYMOUTH | ||||||||
| State: | NH | ||||||||
| PostalCode: | 03264 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6035361104 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/03/2006 | ||||||||
| LastUpdateDate: | 10/20/2015 | ||||||||
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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 | 207V00000X | 10612 | NH | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 10612 | 01 | NH | STATE LICENSE | OTHER | 30200402 | 05 | NH | MEDICAID | 3073722 | 05 | NH | MEDICAID | BE6387270 | 01 | DEA NUMBER | OTHER |