1063684785 NPI number — LORI H MULLER RD LD CDE

Table of content: LORI H MULLER RD LD CDE (NPI 1063684785)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063684785 NPI number — LORI H MULLER RD LD CDE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MULLER
Provider First Name:
LORI
Provider Middle Name:
H
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RD LD CDE
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063684785
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/04/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6 BUTTRICK RD
Provider Second Line Business Mailing Address:
SUITE 120
Provider Business Mailing Address City Name:
LONDONDERRY
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03053-3417
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-537-1300
Provider Business Mailing Address Fax Number:
603-537-1326

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6 TSIENNETO RD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
DERRY
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03038-1584
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-537-1300
Provider Business Practice Location Address Fax Number:
603-537-1326
Provider Enumeration Date:
04/02/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X , with the licence number:  709712 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com