Healthcare Provider Details

I. General information

NPI: 1417407388
Provider Name (Legal Business Name): ALICE PECK DAY MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2016
Last Update Date: 10/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 ALICE PECK DAY DR
LEBANON NH
03766-2900
US

IV. Provider business mailing address

10 ALICE PECK DAY DR
LEBANON NH
03766-2900
US

V. Phone/Fax

Practice location:
  • Phone: 603-443-9548
  • Fax: 603-442-5144
Mailing address:
  • Phone: 603-448-3121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number1021-V
License Number StateNH

VIII. Authorized Official

Name: SUSAN E MOONEY
Title or Position: CEO/PRESIDENT
Credential: M.D., M.S.
Phone: 603-442-5672