Provider Demographics
NPI:1891889788
Name:DEWEY, SAMUEL PARKER (PA)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:PARKER
Last Name:DEWEY
Suffix:
Gender:M
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:PO BOX 2150
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:NH
Mailing Address - Zip Code:03257-2150
Mailing Address - Country:US
Mailing Address - Phone:603-526-5167
Mailing Address - Fax:603-526-5085
Practice Address - Street 1:273 COUNTY RD
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:NH
Practice Address - Zip Code:03257-5736
Practice Address - Country:US
Practice Address - Phone:603-526-5544
Practice Address - Fax:603-526-5085
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0039P363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30009672Medicaid
NH30009672Medicaid
NHAP0768Medicare ID - Type UnspecifiedMEDICARE B