Reverfront Medical Group, PC

Primary specialty

SpecialistTaxonomy code 174400000X

License

11415 Issued in NH

Legal business name

REVERFRONT MEDICAL GROUP, PC

Practice address

322 W Main St
Suite 133
Tilton, NH 03276-5017

Phone

(603) 286-3800

NPI assigned

Apr 17, 2007

Organization subpart

No

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

Authorized official

Name

Susan Marie Hare, M.D.

Title

Owner

Phone

(603) 286-3800

Specialties & licenses 3

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1176768000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1217376000000",
    "number": "1386860716",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "322 W MAIN ST",
            "address_2": "SUITE 133",
            "city": "TILTON",
            "state": "NH",
            "postal_code": "032765017",
            "telephone_number": "603-286-3800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "322 W MAIN ST",
            "address_2": "SUITE 133",
            "city": "TILTON",
            "state": "NH",
            "postal_code": "032765017",
            "telephone_number": "603-286-3800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVERFRONT MEDICAL GROUP, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-17",
        "last_updated": "2008-07-30",
        "status": "A",
        "authorized_official_last_name": "HARE",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "603-286-3800",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "NH",
            "license": "10967",
            "primary": false
        },
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "NH",
            "license": "11415",
            "primary": true
        },
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "NH",
            "license": "0185862302",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30214683",
            "state": "NH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bethanne Potter
• Heidi Leigh Powell, APRN, FNP-BC
• Jean-Paul Rabbath, D.M.D
• Sakinah Rahim, RPH
• Reach Higher ABA New Hampshire, LLC
• Isabel Riggs
• Riverfront Medical Group, PC
• Beth A Roy, DENTAL HYGIENIST
• M. Kathleen Russo, LADC
• Sebastian Dragos Gheorghe Sabadis, PT

• Specialist in Tilton, NH
• Providers in Tilton, NH by specialty
• Specialist in New Hampshire

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.