Basic Information
| Provider Information | |||||||||
| NPI: | 1962442269 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHAMANSKY | ||||||||
| FirstName: | ERIC | ||||||||
| MiddleName: | MATTHEW | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 71 HIGHLAND STREET | ||||||||
| Address2: | |||||||||
| City: | PLYMOUTH | ||||||||
| State: | NH | ||||||||
| PostalCode: | 03264 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6035363700 | ||||||||
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| Practice Location | |||||||||
| Address1: | 71 HIGHLAND ST | ||||||||
| Address2: | |||||||||
| City: | PLYMOUTH | ||||||||
| State: | NH | ||||||||
| PostalCode: | 032641233 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6035363700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2006 | ||||||||
| LastUpdateDate: | 01/10/2012 | ||||||||
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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 | 208000000X | 13182 | NH | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 30206132 | 05 | NH | MEDICAID | 1012813 | 05 | VT | MEDICAID |