Healthcare Provider Details

I. General information

NPI: 1295805950
Provider Name (Legal Business Name): ALICE PECK DAY MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 04/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 ALICE PECK DAY DR
LEBANON NH
03766-2647
US

IV. Provider business mailing address

10 ALICE PECK DAY DR
LEBANON NH
03766-2647
US

V. Phone/Fax

Practice location:
  • Phone: 603-448-7448
  • Fax: 603-443-9516
Mailing address:
  • Phone: 603-448-3121
  • Fax: 603-448-7462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number00016
License Number StateNH
# 3
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number00016
License Number StateNH

VIII. Authorized Official

Name: SUSAN E MOONEY
Title or Position: CEO/PRESIDENT
Credential: MD
Phone: 603-448-3121