Provider Demographics
NPI:1619931235
Name:DELLA GROTTA, SHARON L (MD)
Entity Type:Individual
Prefix:DR
First Name:SHARON
Middle Name:L
Last Name:DELLA GROTTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SHARON
Other - Middle Name:L
Other - Last Name:VAN TUIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:58 HAWTHORNE DR
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110-6912
Mailing Address - Country:US
Mailing Address - Phone:603-622-8619
Mailing Address - Fax:
Practice Address - Street 1:58 HAWTHORNE DR
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110-6912
Practice Address - Country:US
Practice Address - Phone:603-622-8619
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH7306208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30001517Medicaid
NH0105521YPNH01OtherBLUE SHIELD PROVIDER NO