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General NPI Number Information
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NPI Number | 1043508799
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Entity Type | Organization
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Legal Business Name | MERRIMACK VALLEY SLEEP CENTER PLLC
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Dates
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Enumeration Date | 07/15/2011
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Last Update Date | 10/29/2011
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Provider Practice Location Address
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Address Line | 49 ATWOOD RD STE 3
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City | PELHAM
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State | NH
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Zip | 03076-3719
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Country | US
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Telephone | 603-635-7711
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Fax |
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Provider Business Mailing Address
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Address Line | 49 ATWOOD RD STE 3 PO BOX 434
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City | PELHAM
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State | NH
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Zip | 03076-3719
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Country | US
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Telephone | 603-635-7711
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. SRILATHA KODALI
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Credential | M.D.
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Telephone | 603-635-2802
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS1200X
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Taxonomy Name | Sleep Disorder Diagnostic Clinic/Center
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License Number |
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License Number State | NH
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