Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0000X | Internist - Cardiovascular Disease | 042.0013938 | VT |
N | 207RC0000X | Internist - Cardiovascular Disease | 18517 | NH |
Y | 207RC0001X | Clinical Cardiac Electrophysiologist | 18517 | NH |
NPI | 1144546771 |
---|---|
Provider Name | Evan Grove |
First Address | Lebanon, NH 03756-1000 |
Second Address | Lebanon, NH 03756-1000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/04/2010 |
Last Update Date | 02/01/2018 |