Healthcare Provider Details

I. General information

NPI: 1952660847
Provider Name (Legal Business Name): MANCHESTER OBSTETRICAL ASSOCIATES, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2012
Last Update Date: 05/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 TARRYTOWN RD
MANCHESTER NH
03103-2713
US

IV. Provider business mailing address

150 TARRYTOWN RD
MANCHESTER NH
03103-2713
US

V. Phone/Fax

Practice location:
  • Phone: 603-622-3162
  • Fax: 603-622-8677
Mailing address:
  • Phone: 603-622-3162
  • Fax: 603-622-8677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number054314-23
License Number StateNH

VIII. Authorized Official

Name: DR. HEIDI L MEINZ
Title or Position: PRESIDENT
Credential: M.D.
Phone: 603-622-3162