Healthcare Provider Details

I. General information

NPI: 1609691781
Provider Name (Legal Business Name): MICHAEL KELLIHER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2024
Last Update Date: 07/06/2025
Certification Date: 07/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 S RIVER RD STE 100
BEDFORD NH
03110-6927
US

IV. Provider business mailing address

160 S RIVER RD STE 100
BEDFORD NH
03110-6927
US

V. Phone/Fax

Practice location:
  • Phone: 603-665-5150
  • Fax:
Mailing address:
  • Phone: 603-665-5150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number075745-21
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number075745-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: