Provider Demographics
NPI:1518130194
Name:WALLER, HUGH DURWOOD II (PA-C)
Entity Type:Individual
Prefix:MR
First Name:HUGH
Middle Name:DURWOOD
Last Name:WALLER
Suffix:II
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 PLEASANT ST STE 204
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:NH
Mailing Address - Zip Code:03257-5881
Mailing Address - Country:US
Mailing Address - Phone:603-526-4635
Mailing Address - Fax:603-526-2151
Practice Address - Street 1:173 S MAIN ST
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-4713
Practice Address - Country:US
Practice Address - Phone:802-772-4165
Practice Address - Fax:802-855-8489
Is Sole Proprietor?:No
Enumeration Date:2008-04-03
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant