| Wentworth Douglass Physician Corporation | |
|
798 Central Ave Dover NH 03820-2520 | |
| (603) 609-6690 | |
| Not Available |
| Full Name | Wentworth Douglass Physician Corporation |
|---|---|
| Speciality | Counselor - Addiction (substance Use Disorder) |
| Location | 798 Central Ave, Dover, New Hampshire |
| Authorized Official Name and Position | Trisha Gagnon (DIRECTOR REVENUE CYCLE OPERATIONS) |
| Authorized Official Contact | 6037403205 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Wentworth Douglass Physician Corporation Po Box 412503 Boston MA 02241-2503 Ph: (617) 726-3884 | Wentworth Douglass Physician Corporation 798 Central Ave Dover NH 03820-2520 Ph: (603) 609-6690 |
| NPI Number | 1710504683 |
|---|---|
| Provider Enumeration Date | 06/26/2020 |
| Last Update Date | 05/02/2023 |
| Certification Date | 05/02/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710504683 | NPI | - | NPPES |
| 3126909 | Medicaid | NH | |
| 3138637 | Medicaid | NH | |
| 3117235 | Medicaid | NH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Primary |
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