Healthcare Provider Details

I. General information

NPI: 1679526644
Provider Name (Legal Business Name): ANDROSCOGGIN VALLEY HOSPITAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 07/14/2025
Certification Date: 07/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 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: 603-752-2300
  • Fax: 603-752-8231
Mailing address:
  • Phone: 603-752-2300
  • Fax: 603-752-8231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License Number00050
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number00050
License Number StateNH
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number00050
License Number StateNH
# 4
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number00050
License Number StateNH
# 5
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number00050
License Number StateNH
# 6
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number00050
License Number StateNH
# 7
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number00050
License Number StateNH
# 8
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number00050
License Number StateNH
# 9
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number00050
License Number StateNH
# 10
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number00050
License Number StateNH
# 11
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number00050
License Number StateNH
# 12
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number00050
License Number StateNH

VIII. Authorized Official

Name: MR. MICHAEL PETERSON
Title or Position: CEO
Credential:
Phone: 603-752-5601