Healthcare Provider Details

I. General information

NPI: 1518903962
Provider Name (Legal Business Name): MARY DWYER BERMAN ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 04/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 PLEASANT ST
CONCORD NH
03301-7539
US

IV. Provider business mailing address

1 MERRIMACK ST
PENACOOK NH
03303-1402
US

V. Phone/Fax

Practice location:
  • Phone: 603-753-4302
  • Fax: 603-753-6213
Mailing address:
  • Phone: 603-753-4302
  • Fax: 603-753-6213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number027364-21
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: