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General NPI Number Information
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NPI Number | 1326245747
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Entity Type | Individual
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Provider Name | ROLAND A. LAVALLEE MD
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Gender | Male
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Dates
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Enumeration Date | 06/29/2007
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Last Update Date | 05/21/2019
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Provider Practice Location Address
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Address Line | 140 QUEEN CITY AVE
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City | MANCHESTER
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State | NH
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Zip | 03103-7122
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Country | US
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Telephone | 603-626-9500
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Fax |
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Provider Business Mailing Address
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Address Line | 20 HUNTERS RD
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City | BEDFORD
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State | NH
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Zip | 03110-5014
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Country | US
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Telephone | 603-472-4424
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Fax |
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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 | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number | 8396
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License Number State | NH
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | NH 8396
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License Number State | NH
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