Basic Information
| Provider Information | |||||||||
| NPI: | 1801866157 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DEERY | ||||||||
| FirstName: | ELIZA | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1327 | ||||||||
| Address2: | |||||||||
| City: | LACONIA | ||||||||
| State: | NH | ||||||||
| PostalCode: | 032471327 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6035243211 | ||||||||
| FaxNumber: | 6035277038 | ||||||||
| Practice Location | |||||||||
| Address1: | 85 SPRING ST | ||||||||
| Address2: | |||||||||
| City: | LACONIA | ||||||||
| State: | NH | ||||||||
| PostalCode: | 032463113 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6035272970 | ||||||||
| FaxNumber: | 6035272874 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/26/2006 | ||||||||
| LastUpdateDate: | 10/12/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0200X | 9599 | NH | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | 207RP1001X | 9599 | NH | N | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
ID Information
| ID | Type | State | Issuer | Description | F04355 | 01 | NH | HARVARD PILGRIM HLTHCARE | OTHER | 537041 | 01 | NH | CIGNA | OTHER | 0108215Y0NH01 | 01 | NH | ANTHEM | OTHER | 3078709 | 05 | NH | MEDICAID | 383803 | 01 | NH | MVP | OTHER | 3488956 | 01 | NH | AETNA | OTHER |