NPIMap

Individual provider Active NPI

Niaz Memon, M.D.

  • Critical Care Medicine (Internal Medicine) Physician
  • Dover, NH
National Provider Identifier
1386171312
Registry record updated Oct 17, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Care Medicine (Internal Medicine) PhysicianTaxonomy code 207RC0200X
License
22060 Issued in NH
Practice address
801 Central Ave Ste 1
Dover, NH 03820-2529
Phone
(603) 740-9713
NPI assigned
May 22, 2017
Reactivated
Jan 18, 2018
Last updated
Oct 17, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 2020018960 MO
Critical Care Medicine (Internal Medicine) Physician 207RC0200X 22060 NH Primary

Addresses

Primary practice location

801 Central Ave Ste 1
Dover, NH 03820-2529

Mailing address

PO Box 412503
Boston, MA 02241-2503
Phone (617) 726-3884

Other practice location 1

625 S New Ballas Rd Ste 7020
Saint Louis, MO 63141-8218
Phone (314) 251-6486

Other identifiers 1

IdentifierTypeStateIssuer
3135647MedicaidNH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NH
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220728002975 NH Practitioner - Critical Care (Intensivists)Practitioner - Internal Medicine 6406287101 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Critical Care (Intensivists)Also: Internal Medicine
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

789 Central Ave
Dover, NH 03820-2526
Phone (603) 740-4478

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
2020018960MOMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Wentworth Douglass Physician Corporation CurrentSince Aug 1, 2022 Accepting new patients
Wentworth Douglass Physician Corporation CurrentSince Aug 1, 2022 Accepting new patients
Wentworth Douglass Hospital Current Accepting new patients
Wentworth Douglass Hospital Past Accepting new patients

Locations

750 Central Ave
Ste Q
Dover, NH 03820
Phone (603) 742-6030

789 Central Ave
Dover, NH 03820
Phone (603) 740-2832

789 Central Ave
#2
Dover, NH 03820
Phone (603) 609-6096

801 Central Ave
Ste 1
Dover, NH 03820
Phone (603) 740-9713

Interoperability endpoints

  • Direct secure messaging: memon.niaz.wdh@direct.partners.masshiway.net

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1495411200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665964800000",
    "number": "1386171312",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 412503",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022412503",
            "telephone_number": "617-726-3884"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 CENTRAL AVE STE 1",
            "city": "DOVER",
            "state": "NH",
            "postal_code": "038202529",
            "telephone_number": "603-740-9713"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "625 S New Ballas Rd Ste 7020",
            "address_purpose": "LOCATION",
            "city": "Saint Louis",
            "state": "MO",
            "postal_code": "631418218",
            "country_code": "US",
            "telephone_number": "314-251-6486",
            "fax_number": "314-251-4155",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MEMON",
        "first_name": "NIAZ",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-05-22",
        "last_updated": "2022-10-17",
        "certification_date": "2022-10-17",
        "deactivation_date": "2017-12-28",
        "reactivation_date": "2018-01-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MO",
            "license": "2020018960",
            "primary": false
        },
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "NH",
            "license": "22060",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3135647",
            "state": "NH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Dover, NH

Sources for this page

Verify at the official NPI Registry.