=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285999292
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JESSICA L D'AMICO DO
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/06/2012
-----------------------------------------------------
Last Update Date | 03/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3073 WHITE MOUNTAIN HWY
-----------------------------------------------------
City | NORTH CONWAY
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03860-7101
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-356-4914
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3073 WHITE MOUNTAIN HWY
-----------------------------------------------------
City | NORTH CONWAY
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03860-7101
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-356-4835
-----------------------------------------------------
Fax | 603-356-2604
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 5101019731
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | DO2664
-----------------------------------------------------
License Number State | ME
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207RP1001X
-----------------------------------------------------
Taxonomy Name | Pulmonary Disease Physician
-----------------------------------------------------
License Number | DO2664
-----------------------------------------------------
License Number State | ME
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 207RC0200X
-----------------------------------------------------
Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
-----------------------------------------------------
License Number | DO2664
-----------------------------------------------------
License Number State | ME
-----------------------------------------------------