Healthcare Provider Details

I. General information

NPI: 1942691829
Provider Name (Legal Business Name): ALICE PECK DAY MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2015
Last Update Date: 08/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 W PARK ST STE 320
LEBANON NH
03766-1322
US

IV. Provider business mailing address

10 ALICE PECK DAY DR
LEBANON NH
03766-2900
US

V. Phone/Fax

Practice location:
  • Phone: 603-448-3668
  • Fax: 603-727-9137
Mailing address:
  • Phone: 603-448-3121
  • Fax: 603-448-7444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberNH0016
License Number StateNH

VIII. Authorized Official

Name: SUSAN E MOONEY
Title or Position: CEO/PRESIDENT
Credential: MD, MS
Phone: 603-442-4572