Healthcare Provider Details

I. General information

NPI: 1851450241
Provider Name (Legal Business Name): PETER DIAS PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 11/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

172 KINSLEY ST
NASHUA NH
03060-3648
US

IV. Provider business mailing address

172 KINSLEY ST
NASHUA NH
03060-3648
US

V. Phone/Fax

Practice location:
  • Phone: 603-882-3000
  • Fax: 603-889-3774
Mailing address:
  • Phone: 603-882-3000
  • Fax: 603-889-3774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0398
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: