Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 9990 | NH |
NPI | 1235196940 |
---|---|
Provider Name | Dr. Viking A. Hedberg |
First Address | Concord, NH 03301-7559 |
Second Address | Concord, NH 03301-7559 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/04/2006 |
Last Update Date | 30/07/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0RE4460 | (05) | VT |
30010443 | (05) | NH |
F13099 | (02) |