Basic Information
Provider Information | |||||||||
NPI: | 1871522425 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | MERRITHEW | ||||||||
FirstName: | DANA | ||||||||
MiddleName: | A | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 706 | ||||||||
Address2: |   | ||||||||
City: | PLYMOUTH | ||||||||
State: | NH | ||||||||
PostalCode: | 032640706 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3149890300 | ||||||||
FaxNumber: | 6032382163 | ||||||||
Practice Location | |||||||||
Address1: | 103 BOULDER POINT DRIVE | ||||||||
Address2: |   | ||||||||
City: | PLYMOUTH | ||||||||
State: | NH | ||||||||
PostalCode: | 032643168 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6035361881 | ||||||||
FaxNumber: | 6032382198 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/03/2006 | ||||||||
LastUpdateDate: | 12/04/2015 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 6365 | NH | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine |   |
ID Information
ID | Type | State | Issuer | Description | 0100949Y0NH01 | 01 | NH | ANTHEM | OTHER | 42758 | 01 | NH | CIGNA | OTHER | 81110949 | 05 | NH |   | MEDICAID |