Healthcare Provider Details

I. General information

NPI: 1780068098
Provider Name (Legal Business Name): PAUL TIMOTHY HELLINGS BOCO, C.PED
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2015
Last Update Date: 01/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 HARVEY RD STE A105
LONDONDERRY NH
03053
US

IV. Provider business mailing address

136 HARVEY RD STE A105
LONDONDERRY NH
03053-7411
US

V. Phone/Fax

Practice location:
  • Phone: 603-932-2144
  • Fax: 603-935-2947
Mailing address:
  • Phone: 603-932-2144
  • Fax: 603-935-2947

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224L00000X
TaxonomyPedorthist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: