1043491905 NPI number — RONALD W. DOUVILLE PROFESSIONAL ASSOCIATION

Table of content: (NPI 1043491905)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043491905 NPI number — RONALD W. DOUVILLE PROFESSIONAL ASSOCIATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RONALD W. DOUVILLE PROFESSIONAL ASSOCIATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1043491905
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/25/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1059
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MERRIMACK
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03054-1059
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-424-4030
Provider Business Mailing Address Fax Number:
603-424-7277

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
395 DANIEL WEBSTER HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MERRIMACK
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03054-4128
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-424-4030
Provider Business Practice Location Address Fax Number:
603-424-7277
Provider Enumeration Date:
11/20/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DOUVILLE,
Authorized Official First Name:
RONALD
Authorized Official Middle Name:
W
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
603-424-4030

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  355 , 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)

  • Identifier: 80587884 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".