Healthcare Provider Details

I. General information

NPI: 1396252714
Provider Name (Legal Business Name): OLGA MARIA MARDACH-DUCLERC M.SC. L.AC, DIPL. OM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2018
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 OLD ROLLINSFORD RD STE 204
DOVER NH
03820-2869
US

IV. Provider business mailing address

PO BOX 412503
BOSTON MA
02241-2503
US

V. Phone/Fax

Practice location:
  • Phone: 603-740-2130
  • Fax: 603-740-9528
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number365
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: