Healthcare Provider Details

I. General information

NPI: 1043508799
Provider Name (Legal Business Name): MERRIMACK VALLEY SLEEP CENTER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2011
Last Update Date: 10/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 ATWOOD RD STE 3
PELHAM NH
03076-3719
US

IV. Provider business mailing address

49 ATWOOD RD STE 3 PO BOX 434
PELHAM NH
03076-3719
US

V. Phone/Fax

Practice location:
  • Phone: 603-635-7711
  • Fax:
Mailing address:
  • Phone: 603-635-7711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number StateNH

VIII. Authorized Official

Name: DR. SRILATHA KODALI
Title or Position: MANAGER
Credential: M.D.
Phone: 603-635-2802