Healthcare Provider Details

I. General information

NPI: 1033487582
Provider Name (Legal Business Name): LITTLETON HOSPITAL ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2011
Last Update Date: 09/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 YEATON RD DR. DANIEL O'NEILL
PLYMOUTH NH
03264-3457
US

IV. Provider business mailing address

PO BOX 32 PROCLAIM, INC.
ANDOVER NH
03216-0032
US

V. Phone/Fax

Practice location:
  • Phone: 603-536-2270
  • Fax:
Mailing address:
  • Phone: 603-735-6060
  • Fax: 603-735-6070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number02790
License Number StateNH

VIII. Authorized Official

Name: NICHOLAS BRACCINO
Title or Position: CFO
Credential:
Phone: 603-444-9504