Healthcare Provider Details

I. General information

NPI: 1386680593
Provider Name (Legal Business Name): ANDROSCOGGIN VALLEY HOSPITAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 06/25/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

59 PAGE HILL RD
BERLIN NH
03570-3542
US

IV. Provider business mailing address

59 PAGE HILL RD
BERLIN NH
03570-3542
US

V. Phone/Fax

Practice location:
  • Phone: 603-326-5827
  • Fax: 603-326-5832
Mailing address:
  • Phone: 603-326-5827
  • Fax: 603-326-5832

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number00050
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number00050
License Number StateNH
# 3
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number00050
License Number StateNH
# 4
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number00050
License Number StateNH
# 5
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number00050
License Number StateNH
# 6
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number00050
License Number StateNH
# 7
Primary TaxonomyN
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License Number00050
License Number StateNH
# 8
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number00050
License Number StateNH
# 9
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number00050
License Number StateNH
# 10
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number00050
License Number StateNH

VIII. Authorized Official

Name: MS. SUZANNE L LANDRY
Title or Position: VP OF COMPLIANCE AND RISK MANAGMENT
Credential:
Phone: 603-326-5608