Basic Information
| Provider Information | |||||||||
| NPI: | 1891709093 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GESSNER | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | JAY | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 133 PLEASANT ST | ||||||||
| Address2: | |||||||||
| City: | BERLIN | ||||||||
| State: | NH | ||||||||
| PostalCode: | 035702006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6037522040 | ||||||||
| FaxNumber: | 6037523862 | ||||||||
| Practice Location | |||||||||
| Address1: | 2 BROADWAY AVE | ||||||||
| Address2: | |||||||||
| City: | GORHAM | ||||||||
| State: | NH | ||||||||
| PostalCode: | 035811502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6034662741 | ||||||||
| FaxNumber: | 6034662953 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2006 | ||||||||
| LastUpdateDate: | 12/01/2014 | ||||||||
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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 | 156643 | NY | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 5987 | NH | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 3077633 | 05 | NH | MEDICAID |