Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | MT199474 | PA |
N | 111NI0900X | Internist | MT199474 | PA |
Y | 2084N0402X | Child Neurologist | 20288 | NH |
N | 2084N0402X | Child Neurologist | 250908 | MA |
NPI | 1306133293 |
---|---|
Provider Name | Dr. Pooja Santosh Raibagkar |
First Address | Concord, NH 03301-7559 |
Second Address | Concord, NH 03301-2548 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2011 |
Last Update Date | 11/08/2020 |