Provider Demographics
NPI:1639263932
Name:EDDY, DOUGLAS M (MD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:M
Last Name:EDDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 TSIENNETO ROAD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:DERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03038-0038
Mailing Address - Country:US
Mailing Address - Phone:603-216-0400
Mailing Address - Fax:603-216-3800
Practice Address - Street 1:6 TSIENNETO ROAD
Practice Address - Street 2:SUITE 300
Practice Address - City:DERRY
Practice Address - State:NH
Practice Address - Zip Code:03038-0038
Practice Address - Country:US
Practice Address - Phone:603-216-0400
Practice Address - Fax:603-216-3800
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH6888174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH80000965Medicaid
NHNH0965Medicare ID - Type Unspecified
NH80000965Medicaid