MEDICARE: BERT PRIDDLE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	237700000X	Hearing Instrument Specialist	H593	NH

General Provider Information

NPI Number	:	1548505571
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BERT PRIDDLE

Provider Business Mailing Address
First Line	:	869 MAIN ST
Second Line	:	STE 7
City	:	WALPOLE
State	:	MA
Zip	:	02081-2985
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1500 S WILLOW ST
Second Line	:
City	:	MANCHESTER
State	:	NH
Zip	:	03103-3220
Country	:	US
Telephone Number	:	603-622-0899
Fax Number	:	603-622-5048

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/03/2012
Last Update Date	:	12/03/2012

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Directions to “ BERT PRIDDLE ” Practice Location

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