Healthcare Provider Details

I. General information

NPI: 1932269149
Provider Name (Legal Business Name): LISA ALLARD DIBRIGIDA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 09/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1245 ELM STREET
MANCHESTER NH
03101-1308
US

IV. Provider business mailing address

1245 ELM STREET
MANCHESTER NH
03101-1308
US

V. Phone/Fax

Practice location:
  • Phone: 603-668-6629
  • Fax: 603-622-7680
Mailing address:
  • Phone: 603-668-6629
  • Fax: 603-622-7680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number9014
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: