Provider Demographics
NPI:1942266523
Name:DIRITO-HERBERT, NICOLA (DO)
Entity Type:Individual
Prefix:DR
First Name:NICOLA
Middle Name:
Last Name:DIRITO-HERBERT
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 1:81 FIELDSTONE LN
Mailing Address - Street 2:
Mailing Address - City:CANDIA
Mailing Address - State:NH
Mailing Address - Zip Code:03034-2320
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:ONE ELLIOT WAY
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03103-3502
Practice Address - Country:US
Practice Address - Phone:603-663-2830
Practice Address - Fax:603-663-1849
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-24
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH13452207P00000X
FLOS09626207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL274320500Medicaid
35167OtherBCBS OF FL
IN200164270Medicaid
FL816471113AMedicaid
P00279687Medicare PIN
IN200164270Medicaid
35167OtherBCBS OF FL
FL816471113AMedicaid