Basic Information
| Provider Information | |||||||||
| NPI: | 1043236011 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRYSON | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 PARKLAND DR | ||||||||
| Address2: | |||||||||
| City: | DERRY | ||||||||
| State: | NH | ||||||||
| PostalCode: | 030382746 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6034212220 | ||||||||
| FaxNumber: | 6034212223 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 PARKLAND DR | ||||||||
| Address2: | |||||||||
| City: | DERRY | ||||||||
| State: | NH | ||||||||
| PostalCode: | 030382746 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6034212220 | ||||||||
| FaxNumber: | 6034212223 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2006 | ||||||||
| LastUpdateDate: | 01/31/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 0361 | NH | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
ID Information
| ID | Type | State | Issuer | Description | 406980099 | 05 | ME | MEDICAID | 30331772 | 05 | NH | MEDICAID | 970029000 | 01 | NH | RAILROAD THRU SEACOAST | OTHER |