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1780892836

NPI Code Detail

MEDICARE: AMY LEWIS HENNESSY MD

MEDICARE: AMY LEWIS HENNESSY MD

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	207WX0009X	Glaucoma Specialist (Ophthalmology) Physician	17007	NH
2	207W00000X	Ophthalmology Physician	17007	NH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	DH0987	OTHER	MD	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	93408502	OTHER	MD	BC BS
2	123130	OTHER	MD	GEISINGER HEALTH PLAN
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780892836
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY LEWIS HENNESSY MD

Provider Business Mailing Address
First Line	:	250 RIVER RD
Second Line	:
City	:	MANCHESTER
State	:	NH
Zip	:	03104-2423
Country	:	US
Telephone Number	:	603-668-2020
Fax Number	:	603-668-0881

Provider Business Practice Location Address
First Line	:	250 RIVER RD
Second Line	:
City	:	MANCHESTER
State	:	NH
Zip	:	03104-2423
Country	:	US
Telephone Number	:	603-668-2020
Fax Number	:	603-668-0881

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

Provider Enumeration Date	:	05/21/2007
Last Update Date	:	07/21/2022

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Directions to “ AMY LEWIS HENNESSY MD” Practice Location

Language	Start Address	Practice Location

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