Healthcare Provider Details

I. General information

NPI: 1922030493
Provider Name (Legal Business Name): DERRY MEDICAL CENTER, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 TSIENNETO RD SUITE 100
DERRY NH
03038-1584
US

IV. Provider business mailing address

14B TSIENNETO RD
DERRY NH
03038-1560
US

V. Phone/Fax

Practice location:
  • Phone: 603-537-1300
  • Fax: 603-537-1326
Mailing address:
  • Phone: 603-537-1300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: TONYA LYN WILSON
Title or Position: BILLING/CREDENTIALING MANAGER
Credential:
Phone: 603-537-1317