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General NPI Number Information
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NPI Number | 1154309623
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Entity Type | Individual
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Provider Name | ANTHONY J AVERSA M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/05/2006
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Last Update Date | 06/13/2018
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Provider Practice Location Address
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Address Line | 197 LOUDON RD STE 350
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City | CONCORD
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State | NH
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Zip | 03301
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Country | US
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Telephone | 978-691-5690
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Fax | 978-691-5693
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Provider Business Mailing Address
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Address Line | 280 MERRIMACK ST STE 311
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City | LAWRENCE
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State | MA
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Zip | 01843-1779
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Country | US
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Telephone | 978-691-5690
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Fax | 978-691-5693
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 6913
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License Number State | NH
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