Basic Information
| Provider Information | |||||||||
| NPI: | 1730232232 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EMERGENCY PHYSICIANS OF DERRY PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 380 LAFAYETTE RD | ||||||||
| Address2: | |||||||||
| City: | HAMPTON | ||||||||
| State: | NH | ||||||||
| PostalCode: | 038422222 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6034212220 | ||||||||
| FaxNumber: | 6039262853 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 PARKLAND DR | ||||||||
| Address2: | |||||||||
| City: | DERRY | ||||||||
| State: | NH | ||||||||
| PostalCode: | 030382746 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6034212220 | ||||||||
| FaxNumber: | 6034212223 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/19/2007 | ||||||||
| LastUpdateDate: | 05/17/2020 | ||||||||
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| AuthorizedOfficialLastName: | SCOTT | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
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| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 6038584340 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DO | ||||||||
| NPICertificationDate: | 05/17/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207PE0004X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine | Emergency Medical Services |
ID Information
| ID | Type | State | Issuer | Description | 7050638 | 01 | AETNA | OTHER | 9738801 | 05 | MA | MEDICAID | 610557200 | 01 | OWCP | OTHER | AA89561 | 01 | HARVARD PILGRIM | OTHER | 691591 | 01 | TUFTS | OTHER | DC6570 | 01 | RAILROAD MEDICARE | OTHER | 000000037302 | 01 | BMC HEATLHNET PLAN | OTHER | 30213278 | 05 | NH | MEDICAID |