Provider Demographics
NPI:1740238021
Name:DILLON, KASEY (PA)
Entity Type:Individual
Prefix:
First Name:KASEY
Middle Name:
Last Name:DILLON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 MCGREGOR ST
Mailing Address - Street 2:EMERGENCY DEPT
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03102-3730
Mailing Address - Country:US
Mailing Address - Phone:603-663-6472
Mailing Address - Fax:603-663-6645
Practice Address - Street 1:100 MCGREGOR ST
Practice Address - Street 2:EMERGENCY DEPT
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03102-3730
Practice Address - Country:US
Practice Address - Phone:603-663-6472
Practice Address - Fax:603-663-6645
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2008-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3255363AM0700X
NH0607363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ976863Medicaid
NH30334886Medicaid
ME433002999Medicaid
NHP00634690OtherRAILROAD MEDICARE
NHAP278901Medicare PIN
NHP00634690OtherRAILROAD MEDICARE
107013Medicare ID - Type Unspecified
NH30334886Medicaid