Provider Demographics
NPI:1518990514
Name:LONDONDERRY PEDIATRICS, PA
Entity Type:Organization
Organization Name:LONDONDERRY PEDIATRICS, PA
Other - Org Name:LONDONDERRY PEDIATRICS, PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JEANNINE
Authorized Official - Middle Name:T
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-425-6276
Mailing Address - Street 1:25 BUTTRICK RD
Mailing Address - Street 2:BLDG. E
Mailing Address - City:LONDONDERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03053-3341
Mailing Address - Country:US
Mailing Address - Phone:603-437-1003
Mailing Address - Fax:603-421-0868
Practice Address - Street 1:25 BUTTRICK RD
Practice Address - Street 2:BLDG. E
Practice Address - City:LONDONDERRY
Practice Address - State:NH
Practice Address - Zip Code:03053-3341
Practice Address - Country:US
Practice Address - Phone:603-437-1003
Practice Address - Fax:603-421-0868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30212202Medicaid