Basic Information
| Provider Information | |||||||||
| NPI: | 1316940802 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DREFFER | ||||||||
| FirstName: | DOUGLAS | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| 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 STE 100 | ||||||||
| Address2: | |||||||||
| City: | DERRY | ||||||||
| State: | NH | ||||||||
| PostalCode: | 03038 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6035371300 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/27/2005 | ||||||||
| LastUpdateDate: | 08/08/2018 | ||||||||
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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 | 207Q00000X | 10861 | NH | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 01Y002400NH01 | 01 | NH | ANTHEM ID# FHC | OTHER | 222594672 | 01 | NH | GREATWEST HEALTHCARE ID# | OTHER | P00059817 | 01 | NH | RAIDROAD MEDICARE ID# | OTHER | 2139325 | 01 | NH | CIGNA ID# | OTHER | 30200816 | 05 | NH | MEDICAID | NH1855 | 01 | NH | HARVARD PILGRIM ID# FHC | OTHER | 01YP02400NH01 | 01 | NH | ANTHEM ID # | OTHER | 222594672 | 01 | NH | HEALTH CARE VALUE MANAGE# | OTHER | 222594672 | 01 | NH | PRIVATE HEALTH CARE ID# | OTHER | 4126889 | 01 | NH | MVP ID# | OTHER | 01-40641 | 01 | NH | UNITED HEALTHCARE ID# | OTHER | 2500010 | 01 | NH | AETNA ID# | OTHER | NH1835 | 01 | NH | HARVARD PILGRIM ID# | OTHER |