Provider Demographics
NPI:1679542369
Name:LEVERETT, TERESA M (DO)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:M
Last Name:LEVERETT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 LAFAYETTE RD STE 4
Mailing Address - Street 2:
Mailing Address - City:NORTH HAMPTON
Mailing Address - State:NH
Mailing Address - Zip Code:03862-2461
Mailing Address - Country:US
Mailing Address - Phone:603-373-8700
Mailing Address - Fax:603-319-8154
Practice Address - Street 1:200 LAFAYETTE RD STE 4
Practice Address - Street 2:
Practice Address - City:NORTH HAMPTON
Practice Address - State:NH
Practice Address - Zip Code:03862-2461
Practice Address - Country:US
Practice Address - Phone:603-373-7000
Practice Address - Fax:603-319-8154
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2018-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH9658207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH80004352Medicaid
NHRE4352Medicare ID - Type Unspecified
E29507Medicare UPIN