Healthcare Provider Details

I. General information

NPI: 1730232232
Provider Name (Legal Business Name): EMERGENCY PHYSICIANS OF DERRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 05/17/2020
Certification Date: 05/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PARKLAND DR
DERRY NH
03038-2746
US

IV. Provider business mailing address

380 LAFAYETTE RD
HAMPTON NH
03842-2222
US

V. Phone/Fax

Practice location:
  • Phone: 603-421-2220
  • Fax: 603-421-2223
Mailing address:
  • Phone: 603-421-2220
  • Fax: 603-926-2853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier7050638
Identifier TypeOTHER
Identifier State
Identifier IssuerAETNA
# 2
Identifier9738801
Identifier TypeMEDICAID
Identifier StateMA
Identifier Issuer
# 3
Identifier610557200
Identifier TypeOTHER
Identifier State
Identifier IssuerOWCP
# 4
IdentifierAA89561
Identifier TypeOTHER
Identifier State
Identifier IssuerHARVARD PILGRIM
# 5
Identifier691591
Identifier TypeOTHER
Identifier State
Identifier IssuerTUFTS
# 6
IdentifierDC6570
Identifier TypeOTHER
Identifier State
Identifier IssuerRAILROAD MEDICARE
# 7
Identifier000000037302
Identifier TypeOTHER
Identifier State
Identifier IssuerBMC HEATLHNET PLAN
# 8
Identifier30213278
Identifier TypeMEDICAID
Identifier StateNH
Identifier Issuer

VIII. Authorized Official

Name: THOMAS SCOTT
Title or Position: MEDICAL DIRECTOR
Credential: DO
Phone: 603-858-4340