Provider Demographics
NPI:1245383850
Name:MCAVOY, RICHARD
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:MCAVOY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 ROUTE 108
Mailing Address - Street 2:SUITE 3
Mailing Address - City:SOMERSWORTH
Mailing Address - State:NH
Mailing Address - Zip Code:03878-1119
Mailing Address - Country:US
Mailing Address - Phone:603-742-7492
Mailing Address - Fax:603-742-6762
Practice Address - Street 1:237 ROUTE 108
Practice Address - Street 2:SUITE 101
Practice Address - City:SOMERSWORTH
Practice Address - State:NH
Practice Address - Zip Code:03878-1517
Practice Address - Country:US
Practice Address - Phone:603-749-6686
Practice Address - Fax:603-750-3174
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1494225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH0802560Y0NH01OtherANTHEM
NH30010824Medicaid