Basic Information
| Provider Information | |||||||||
| NPI: | 1386615409 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SIROTY | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 808 | ||||||||
| Address2: | |||||||||
| City: | NASHUA | ||||||||
| State: | NH | ||||||||
| PostalCode: | 030610808 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6035785054 | ||||||||
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| Practice Location | |||||||||
| Address1: | 173 DANIEL WEBSTER HWY | ||||||||
| Address2: | |||||||||
| City: | NASHUA | ||||||||
| State: | NH | ||||||||
| PostalCode: | 030605224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6038914400 | ||||||||
| FaxNumber: | 6038914414 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/27/2006 | ||||||||
| LastUpdateDate: | 05/13/2013 | ||||||||
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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 | 207R00000X | 9230 | NH | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 207K00000X | 9230 | NH | N | Allopathic & Osteopathic Physicians | Allergy & Immunology |
ID Information
| ID | Type | State | Issuer | Description | 80003159 | 05 | NH | MEDICAID |