Provider Demographics
NPI:1649581232
Name:ALICE PECK DAY MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:ALICE PECK DAY MEMORIAL HOSPITAL
Other - Org Name:NEUROSURGERY SERVICE AT APD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:MOONEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:603-448-3121
Mailing Address - Street 1:10 ALICE PECK DAY DR
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03766-2647
Mailing Address - Country:US
Mailing Address - Phone:603-448-3121
Mailing Address - Fax:603-448-7462
Practice Address - Street 1:106 HANOVER ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03766-1042
Practice Address - Country:US
Practice Address - Phone:603-448-0447
Practice Address - Fax:603-448-0019
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALICE PECK DAY MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-06-29
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH11711207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1018305Medicaid
NH30218589Medicaid
NH0019552Medicare PIN