Basic Information
| Provider Information | |||||||||
| NPI: | 1215183751 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WALLUS | ||||||||
| FirstName: | HARRY | ||||||||
| MiddleName: | JOSEPH | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 74 PLEASANT ST | ||||||||
| Address2: | STE 204 | ||||||||
| City: | NEW LONDON | ||||||||
| State: | NH | ||||||||
| PostalCode: | 032575881 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6039260088 | ||||||||
| FaxNumber: | 6039262853 | ||||||||
| Practice Location | |||||||||
| Address1: | 333 BORTHWICK AVE | ||||||||
| Address2: | |||||||||
| City: | PORTSMOUTH | ||||||||
| State: | NH | ||||||||
| PostalCode: | 038017128 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6034334012 | ||||||||
| FaxNumber: | 6034335184 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2008 | ||||||||
| LastUpdateDate: | 01/11/2017 | ||||||||
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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 | 207P00000X | 260578 | NY | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | T0638 | NH | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 03351484 | 05 | NY | MEDICAID |