1427080761 NPI number — LILLIAN E ETERIAN DC

Table of content: LILLIAN E ETERIAN DC (NPI 1427080761)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427080761 NPI number — LILLIAN E ETERIAN DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ETERIAN
Provider First Name:
LILLIAN
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DC
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:
1427080761
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/02/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16 MANNING ST
Provider Second Line Business Mailing Address:
SUITE 107
Provider Business Mailing Address City Name:
DERRY
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03038
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-434-1177
Provider Business Mailing Address Fax Number:
603-434-9992

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16 MANNING ST
Provider Second Line Business Practice Location Address:
SUITE 107
Provider Business Practice Location Address City Name:
DERRY
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03038
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-434-1177
Provider Business Practice Location Address Fax Number:
603-434-9992
Provider Enumeration Date:
07/07/2006

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: 111N00000X , with the licence number:  5521298 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 111N00000X , with the licence number: CH1306 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 111N00000X , with the licence number: DC00272 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1725085 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2516824 . This is a "AETNA" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: T53559 . This is a "HARVARD PILGRIM HLTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 30252493 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 338764 . This is a "PHCS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 05Y003758NH03 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".




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