Basic Information
| Provider Information | |||||||||
| NPI: | 1992879936 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MONADNOCK ORTHOPAEDIC ASSOCIATES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 458 OLD STREET RD | ||||||||
| Address2: | STE 200 | ||||||||
| City: | PETERBOROUGH | ||||||||
| State: | NH | ||||||||
| PostalCode: | 034581265 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6039242144 | ||||||||
| FaxNumber: | 6039243993 | ||||||||
| Practice Location | |||||||||
| Address1: | 458 OLD STREET RD | ||||||||
| Address2: | STE 200 | ||||||||
| City: | PETERBOROUGH | ||||||||
| State: | NH | ||||||||
| PostalCode: | 034581265 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6039242144 | ||||||||
| FaxNumber: | 6039243993 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/20/2006 | ||||||||
| LastUpdateDate: | 05/29/2008 | ||||||||
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| AuthorizedOfficialLastName: | WHITE | ||||||||
| AuthorizedOfficialFirstName: | W | ||||||||
| AuthorizedOfficialMiddleName: | BRADLEY | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6039242144 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 10599 | NH | Y | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.