Healthcare Provider Details

I. General information

NPI: 1720251077
Provider Name (Legal Business Name): JENNIFER A LACY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2008
Last Update Date: 07/24/2020
Certification Date: 07/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

246 PLEASANT STREET MEMORIAL BUILDING, WEST, GROUND FLO
CONCORD NH
03301-2588
US

IV. Provider business mailing address

246 PLEASANT STREET MEMORIAL BUILDING, WEST, GROUND FLO
CONCORD NH
03301-2588
US

V. Phone/Fax

Practice location:
  • Phone: 603-224-9661
  • Fax: 603-228-7051
Mailing address:
  • Phone: 603-224-9661
  • Fax: 603-228-7051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number15384
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number15384
License Number StateNH
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number15384
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: