Provider Demographics
NPI:1043495328
Name:VALLEY UROLOGISTS, PA
Entity Type:Organization
Organization Name:VALLEY UROLOGISTS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:PHILIP
Authorized Official - Last Name:CRICCO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:603-542-7669
Mailing Address - Street 1:340 MAIN ST
Mailing Address - Street 2:STE. 670
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01608-1604
Mailing Address - Country:US
Mailing Address - Phone:508-754-3566
Mailing Address - Fax:508-798-8021
Practice Address - Street 1:5 DUNNING ST
Practice Address - Street 2:
Practice Address - City:CLAREMONT
Practice Address - State:NH
Practice Address - Zip Code:03743-2070
Practice Address - Country:US
Practice Address - Phone:603-542-7669
Practice Address - Fax:603-543-1323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-04
Last Update Date:2009-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH6007208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH82346864Medicaid
NH82346864Medicaid