Provider Demographics
NPI:1902864077
Name:SOARES, EUGENE R (MD)
Entity Type:Individual
Prefix:
First Name:EUGENE
Middle Name:R
Last Name:SOARES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:789 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-2526
Mailing Address - Country:US
Mailing Address - Phone:603-516-0092
Mailing Address - Fax:603-516-0093
Practice Address - Street 1:10 MEMBERS WAY STE 401
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-5933
Practice Address - Country:US
Practice Address - Phone:603-516-0092
Practice Address - Fax:603-516-0093
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH7335207SG0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207SG0205XAllopathic & Osteopathic PhysiciansMedical GeneticsPh.D. Medical Genetics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH20115YOtherANTHEM PROVIDER #
NH8169367-001OtherCIGNA PROVIDER #
NHNH10421OtherHARVARD PILGRIM PROVIDER#
NH30001481Medicaid
NH4507809OtherAETNA PROVIDER #