1902921968 NPI number — MRS. ELIZABETH MARY CLEASBY PTLA

Table of content: MRS. ELIZABETH MARY CLEASBY PTLA (NPI 1902921968)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902921968 NPI number — MRS. ELIZABETH MARY CLEASBY PTLA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CLEASBY
Provider First Name:
ELIZABETH
Provider Middle Name:
MARY
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PTLA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KILEY
Provider Other First Name:
ELIZABETH
Provider Other Middle Name:
MARY
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
PT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1902921968
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5 GEORGE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUDSON
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03051
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-598-0729
Provider Business Mailing Address Fax Number:
603-598-0864

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5 GEORGE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUDSON
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03051
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-598-0729
Provider Business Practice Location Address Fax Number:
603-598-0864
Provider Enumeration Date:
03/20/2007

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: 225100000X , with the licence number:  1360 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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