Provider Demographics
NPI:1770519969
Name:SALEM NEW HAMPSHIRE PHYSICIANS NETWORK PC
Entity type:Organization
Organization Name:SALEM NEW HAMPSHIRE PHYSICIANS NETWORK PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VARTAN
Authorized Official - Middle Name:
Authorized Official - Last Name:YEGHIAZARIANS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-685-5627
Mailing Address - Street 1:411 MERRIMACK ST
Mailing Address - Street 2:
Mailing Address - City:METHUEN
Mailing Address - State:MA
Mailing Address - Zip Code:01844
Mailing Address - Country:US
Mailing Address - Phone:978-685-5627
Mailing Address - Fax:978-688-3987
Practice Address - Street 1:289 MAIN ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:NH
Practice Address - Zip Code:03079
Practice Address - Country:US
Practice Address - Phone:603-898-6363
Practice Address - Fax:603-898-6158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-23
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9783172Medicaid
MAM16469OtherBCBS OF MA
MA607886OtherTUFTS