1487790499 NPI number — MELLISA MARIE HOLLAND

Table of content: MELLISA MARIE HOLLAND (NPI 1487790499)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487790499 NPI number — MELLISA MARIE HOLLAND

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOLLAND
Provider First Name:
MELLISA
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
COGNATA
Provider Other First Name:
MELLISA
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1487790499
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/25/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
73 NEWTON RD
Provider Second Line Business Mailing Address:
STE 101
Provider Business Mailing Address City Name:
PLAISTOW
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03865-2424
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-388-7272
Provider Business Mailing Address Fax Number:
978-388-7373

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
297 DANIEL WEBSTER HWY
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
MERRIMACK
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03054-4451
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-262-3305
Provider Business Practice Location Address Fax Number:
603-262-3306
Provider Enumeration Date:
01/29/2007

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:  3200 , 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: 7819287 . This is a "CIGNA GROUP #" identifier . This identifiers is of the category "OTHER".
  • Identifier: AA 11345 . This is a "HARVARD PILGRIM GROUP #" identifier . This identifiers is of the category "OTHER".
  • Identifier: 08Y011430NH01 . This is a "ANTHEM INDIV. #" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".




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