Healthcare Provider Details

I. General information

NPI: 1134498546
Provider Name (Legal Business Name): PETER A MESSINA II R.P.A,
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2011
Last Update Date: 12/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 STILES RD
SALEM NH
03079-2859
US

IV. Provider business mailing address

53 WELLS VILLAGE RD
SANDOWN NH
03873-2327
US

V. Phone/Fax

Practice location:
  • Phone: 603-893-4352
  • Fax:
Mailing address:
  • Phone: 603-887-4270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License Number08360
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code243U00000X
TaxonomyRadiology Practitioner Assistant
License Number08360
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: