Basic Information
Provider Information | |||||||||
NPI: | 1033350749 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | DAWSON | ||||||||
FirstName: | JAMES | ||||||||
MiddleName: | D | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: | JR. | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 6 BUTTRICK RD STE 102 | ||||||||
Address2: |   | ||||||||
City: | LONDONDERRY | ||||||||
State: | NH | ||||||||
PostalCode: | 030533417 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6035371300 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 6 TSIENNETO RD | ||||||||
Address2: |   | ||||||||
City: | DERRY | ||||||||
State: | NH | ||||||||
PostalCode: | 030381584 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6035371300 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 03/11/2009 | ||||||||
LastUpdateDate: | 12/23/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 12/23/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 0718 | NH | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |   |
ID Information
ID | Type | State | Issuer | Description | P00903682 | 01 | NH | RAILROAD MEDICARE | OTHER | 30337377 | 05 | NH |   | MEDICAID | 434097299 | 05 | ME |   | MEDICAID |