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NPI Code Detail

MEDICARE: LEISA L MAXWELL DO

MEDICARE: LEISA L MAXWELL DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianT0649ME
2207Q00000XFamily Medicine Physician2003TN
3207Q00000XFamily Medicine Physician15719NH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1154434462
Entity Type Code : Individual
Provider Name (Legal Business Name) : LEISA L MAXWELL DO
Provider Business Mailing Address
First Line : PO BOX 3677
Second Line :
City : NASHUA
State : NH
Zip : 03061-3677
Country : US
Telephone Number : 603-577-7900
Fax Number : 603-577-7972
Provider Business Practice Location Address
First Line : 300 DERRY RD
Second Line :
City : HUDSON
State : NH
Zip : 03051-3023
Country : US
Telephone Number : 603-886-3979
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/17/2006
Last Update Date : 03/05/2015

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Directions to “ LEISA L MAXWELL DO” Practice Location

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