Healthcare Provider Details

I. General information

NPI: 1376324533
Provider Name (Legal Business Name): PUDDLE DOCK PEDIATRICS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2023
Last Update Date: 10/12/2023
Certification Date: 10/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 GRIFFIN RD STE 12A
PORTSMOUTH NH
03801-7145
US

IV. Provider business mailing address

200 GRIFFIN RD STE 12A
PORTSMOUTH NH
03801-7145
US

V. Phone/Fax

Practice location:
  • Phone: 603-457-7040
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ALYSSA REYES SMITH
Title or Position: OWNER/PHYSICIAN
Credential: MD
Phone: 603-457-7040