Healthcare Provider Details

I. General information

NPI: 1497951222
Provider Name (Legal Business Name): ROYA VAKILI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2007
Last Update Date: 08/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

87 MCGREGOR STREET
MANCHESTER NH
03102
US

IV. Provider business mailing address

87 MCGREGOR STREET
MANCHESTER NH
03102
US

V. Phone/Fax

Practice location:
  • Phone: 603-695-2940
  • Fax:
Mailing address:
  • Phone: 603-695-2940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number19021
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: