Provider Demographics
NPI:1801866157
Name:DEERY, ELIZA A (MD)
Entity Type:Individual
Prefix:
First Name:ELIZA
Middle Name:A
Last Name:DEERY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1327
Mailing Address - Street 2:
Mailing Address - City:LACONIA
Mailing Address - State:NH
Mailing Address - Zip Code:03247-1327
Mailing Address - Country:US
Mailing Address - Phone:603-524-3211
Mailing Address - Fax:603-527-7038
Practice Address - Street 1:85 SPRING ST
Practice Address - Street 2:
Practice Address - City:LACONIA
Practice Address - State:NH
Practice Address - Zip Code:03246-3113
Practice Address - Country:US
Practice Address - Phone:603-527-2970
Practice Address - Fax:603-527-2874
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH9599207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHF04355OtherHARVARD PILGRIM HLTHCARE
NH537041OtherCIGNA
NH0108215Y0NH01OtherANTHEM
NH3078709Medicaid
NH383803OtherMVP
NH3488956OtherAETNA
NH3488956OtherAETNA
NHF04355Medicare UPIN