Basic Information
| Provider Information | |||||||||
| NPI: | 1942266523 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DIRITO-HERBERT | ||||||||
| FirstName: | NICOLA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 81 FIELDSTONE LN | ||||||||
| Address2: | |||||||||
| City: | CANDIA | ||||||||
| State: | NH | ||||||||
| PostalCode: | 030342320 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | ONE ELLIOT WAY | ||||||||
| Address2: | |||||||||
| City: | MANCHESTER | ||||||||
| State: | NH | ||||||||
| PostalCode: | 031033502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6036632830 | ||||||||
| FaxNumber: | 6036631849 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/24/2006 | ||||||||
| LastUpdateDate: | 05/21/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 13452 | NH | Y | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | OS09626 | FL | N | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 274320500 | 05 | FL | MEDICAID | 35167 | 01 | BCBS OF FL | OTHER | 200164270 | 05 | IN | MEDICAID | 816471113A | 05 | FL | MEDICAID |