Healthcare Provider Details

I. General information

NPI: 1154477305
Provider Name (Legal Business Name): PELHAM HEALTHCARE ASSOCIATES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2007
Last Update Date: 04/11/2024
Certification Date: 04/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 ATWOOD RD STE 1
PELHAM NH
03076-3752
US

IV. Provider business mailing address

49 ATWOOD RD STE 1
PELHAM NH
03076-3752
US

V. Phone/Fax

Practice location:
  • Phone: 603-635-2802
  • Fax: 603-635-3070
Mailing address:
  • Phone: 603-635-2802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: SRILATHA KODALI
Title or Position: OWNER
Credential: MD
Phone: 603-635-2802