Provider Demographics
NPI:1417167792
Name:NEUROLOGY ASSOCIATES OF SOUTHERN NH,PA
Entity Type:Organization
Organization Name:NEUROLOGY ASSOCIATES OF SOUTHERN NH,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:BOTSFORD
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:603-669-0859
Mailing Address - Street 1:769 S MAIN ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03102-5166
Mailing Address - Country:US
Mailing Address - Phone:603-669-0859
Mailing Address - Fax:
Practice Address - Street 1:769 S MAIN ST
Practice Address - Street 2:SUITE 101
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03102-5166
Practice Address - Country:US
Practice Address - Phone:603-669-0859
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH6124174400000X
NH7865174400000X
NH6351174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH81130402Medicaid
NH81130401Medicaid
NH81136923Medicaid
NHNH6923Medicare ID - Type Unspecified
NH81130401Medicaid
NHC65978Medicare UPIN
NH81136923Medicaid
NH81130402Medicaid
NHE34500Medicare UPIN
NHNH9723Medicare ID - Type Unspecified