Basic Information
Provider Information | |||||||||
NPI: | 1770586497 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | DANCA | ||||||||
FirstName: | MARY | ||||||||
MiddleName: | A | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 250 PLEASANT ST | ||||||||
Address2: |   | ||||||||
City: | CONCORD | ||||||||
State: | NH | ||||||||
PostalCode: | 033017539 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6032287200 | ||||||||
FaxNumber: | 6032287307 | ||||||||
Practice Location | |||||||||
Address1: | 250 PLEASANT ST | ||||||||
Address2: |   | ||||||||
City: | CONCORD | ||||||||
State: | NH | ||||||||
PostalCode: | 033017539 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6032287200 | ||||||||
FaxNumber: | 6032287307 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/27/2005 | ||||||||
LastUpdateDate: | 07/09/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | X | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 11241 | NH | Y |   | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |   |
ID Information
ID | Type | State | Issuer | Description | 01Y003092NH01 | 01 | NH | ANTHEM ID # | OTHER | 3049618 | 01 | NH | AETNA INS ID # | OTHER | 8030001 | 05 | NH |   | MEDICAID | 07-01576 | 01 | NH | UNITED HEALTH CARE ID# | OTHER | 13879 | 01 | NH | HARVARD PILGRIM ID# | OTHER | 371524 | 01 | NH | MVP HEALTHCARE ID# | OTHER | 37325 | 01 | NH | CIGNA ID # | OTHER |