Healthcare Provider Details

I. General information

NPI: 1154309623
Provider Name (Legal Business Name): ANTHONY J AVERSA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2006
Last Update Date: 06/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

197 LOUDON RD STE 350
CONCORD NH
03301
US

IV. Provider business mailing address

280 MERRIMACK ST STE 311
LAWRENCE MA
01843-1779
US

V. Phone/Fax

Practice location:
  • Phone: 978-691-5690
  • Fax: 978-691-5693
Mailing address:
  • Phone: 978-691-5690
  • Fax: 978-691-5693

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number6913
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: