Provider Demographics
NPI:1154477305
Name:PELHAM HEALTHCARE ASSOCIATES PLLC
Entity Type:Organization
Organization Name:PELHAM HEALTHCARE ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SRILATHA
Authorized Official - Middle Name:
Authorized Official - Last Name:KODALI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:603-635-2802
Mailing Address - Street 1:49 ATWOOD RD STE 1
Mailing Address - Street 2:
Mailing Address - City:PELHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03076-3752
Mailing Address - Country:US
Mailing Address - Phone:603-635-2802
Mailing Address - Fax:
Practice Address - Street 1:49 ATWOOD RD STE 1
Practice Address - Street 2:
Practice Address - City:PELHAM
Practice Address - State:NH
Practice Address - Zip Code:03076-3752
Practice Address - Country:US
Practice Address - Phone:603-635-2802
Practice Address - Fax:603-635-3070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-28
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3197352Medicaid
NH30200262Medicaid
NHG91492Medicare UPIN
NHRE8586Medicare ID - Type Unspecified
NHNP4960Medicare ID - Type Unspecified
NHRE5241Medicare ID - Type Unspecified