MEDICARE: DR. STACY L TELA DVM

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
1	174M00000X	Veterinarian	1801	NH

General Provider Information

NPI Number	:	1679915771
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STACY L TELA DVM

Provider Business Mailing Address
First Line	:	108 FISHERVILLE RD
Second Line	:
City	:	CONCORD
State	:	NH
Zip	:	03303-1003
Country	:	US
Telephone Number	:	603-229-0674
Fax Number	:

Provider Business Practice Location Address
First Line	:	108 FISHERVILLE RD
Second Line	:
City	:	CONCORD
State	:	NH
Zip	:	03303-1003
Country	:	US
Telephone Number	:	603-229-0674
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2013
Last Update Date	:	07/18/2013

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