Basic Information
| Provider Information | |||||||||
| NPI: | 1992740989 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | ELDER | ||||||||
| FirstName: | NATHAN | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 ELLIOT WAY | ||||||||
| Address2: | EMERGENCY DEPARTMENT | ||||||||
| City: | MANCHESTER | ||||||||
| State: | NH | ||||||||
| PostalCode: | 031033502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6036632830 | ||||||||
| FaxNumber: | 6036631849 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 ELLIOT WAY | ||||||||
| Address2: | EMERGENCY DEPARTMENT | ||||||||
| City: | MANCHESTER | ||||||||
| State: | NH | ||||||||
| PostalCode: | 031033502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6036632830 | ||||||||
| FaxNumber: | 6036631849 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/17/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 207P00000X | 11054 | NH | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 45407 | 01 | NH | HPHC | OTHER | 01Y002796NH02 | 01 | NH | ANTHEM BCBS | OTHER | 30203569 | 05 | NH | MEDICAID |