Provider Demographics
NPI:1659537728
Name:DUBAY, WASSERMAN, CONWAY, MD, PA
Entity Type:Organization
Organization Name:DUBAY, WASSERMAN, CONWAY, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:B
Authorized Official - Last Name:WASSERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:603-883-3365
Mailing Address - Street 1:3 MONIAS DRIVE
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03062
Mailing Address - Country:US
Mailing Address - Phone:603-883-3365
Mailing Address - Fax:603-883-5758
Practice Address - Street 1:30 DANIEL WEBSTER HIGHWAY
Practice Address - Street 2:SUITE 11
Practice Address - City:MERRIMACK
Practice Address - State:NH
Practice Address - Zip Code:03054
Practice Address - Country:US
Practice Address - Phone:603-883-3365
Practice Address - Fax:603-883-5758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-29
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30212712Medicaid