Provider Demographics
NPI:1780892836
Name:HENNESSY, AMY LEWIS (MD)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:LEWIS
Last Name:HENNESSY
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 1:250 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03104-2423
Mailing Address - Country:US
Mailing Address - Phone:603-668-2020
Mailing Address - Fax:603-668-0881
Practice Address - Street 1:250 RIVER RD
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03104-2423
Practice Address - Country:US
Practice Address - Phone:603-668-2020
Practice Address - Fax:603-668-0881
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH17007207WX0009X, 207W00000X
CAA122309207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0009XAllopathic & Osteopathic PhysiciansOphthalmologyGlaucoma Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD93408502OtherBC BS
MD123130OtherGEISINGER HEALTH PLAN
MD019616900Medicaid
MDDH0987OtherMEDICARE RAILROAD
PA127144SRZMedicare PIN
MD123130OtherGEISINGER HEALTH PLAN