Healthcare Provider Details

I. General information

NPI: 1861606220
Provider Name (Legal Business Name): ROBERT SCOTT DESHANE PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL CENTER DR DARTMOUTH HITCHCOCK - NEURO-CRITICAL CARE
LEBANON NH
03756
US

IV. Provider business mailing address

1 MEDICAL CENTER DR DARTMOUTH HITCHCOCK - NEURO-CRITICAL CARE
LEBANON NH
03756
US

V. Phone/Fax

Practice location:
  • Phone: 603-650-5104
  • Fax:
Mailing address:
  • Phone: 603-650-5104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA101824
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601004991
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1417
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: