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General NPI Number Information
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NPI Number | 1376555607
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Entity Type | Individual
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Provider Name | MICHELE ANN VANDER HEYDEN M.D.
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Gender | Female
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Dates
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Enumeration Date | 08/13/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1 MEDICAL CENTER DR DARTMOUTH-HITCHCOCK MEDICAL CENTER
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City | LEBANON
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State | NH
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Zip | 03756-1000
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Country | US
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Telephone | 603-650-5599
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Fax |
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Provider Business Mailing Address
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Address Line | 1 MEDICAL CENTER DRIVE DARTMOUTH-HITCHCOCK MEDICAL CENTER
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City | LEBANON
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State | NH
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Zip | 03756-0001
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Country | US
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Telephone | 603-650-5599
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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 | 2080P0203X
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Taxonomy Name | Pediatric Critical Care Medicine Physician
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License Number | 11888
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License Number State | NH
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