Provider Demographics
NPI:1902870256
Name:YEGANEH, EDMOND Y (MD)
Entity Type:Individual
Prefix:DR
First Name:EDMOND
Middle Name:Y
Last Name:YEGANEH
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 1:330 BORTHWICK AVE
Mailing Address - Street 2:SUITE 304
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-4174
Mailing Address - Country:US
Mailing Address - Phone:603-431-3477
Mailing Address - Fax:603-430-9663
Practice Address - Street 1:330 BORTHWICK AVE
Practice Address - Street 2:SUITE 304
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-4174
Practice Address - Country:US
Practice Address - Phone:603-431-3477
Practice Address - Fax:603-430-9663
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-14
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH5840207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30202280Medicaid
NHB86138Medicare UPIN
NH30202280Medicaid