Provider Demographics
NPI:1245380500
Name:BRILL, LESSA ANN (MD)
Entity Type:Individual
Prefix:
First Name:LESSA
Middle Name:ANN
Last Name:BRILL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 FRANCE RD
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:NH
Mailing Address - Zip Code:03825-3028
Mailing Address - Country:US
Mailing Address - Phone:603-664-5974
Mailing Address - Fax:
Practice Address - Street 1:12 BALLARD ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NH
Practice Address - Zip Code:03824-2308
Practice Address - Country:US
Practice Address - Phone:603-862-1530
Practice Address - Fax:603-862-4259
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH9764208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH20241YMedicare UPIN