1699921858 NPI number — CAROL A BRODY

Table of content: (NPI 1699921858)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699921858 NPI number — CAROL A BRODY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAROL A BRODY
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:
6
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:
1699921858
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/26/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
102 COURT ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LACONIA
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03246-3635
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-528-5020
Provider Business Mailing Address Fax Number:
603-528-0352

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
102 COURT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LACONIA
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03246-3635
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-528-5020
Provider Business Practice Location Address Fax Number:
603-528-0352
Provider Enumeration Date:
08/07/2008

Additional Information

Authorized Official

Authorized Official Last Name:
BRODY
Authorized Official First Name:
SPENCER
Authorized Official Middle Name:
JOHN
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
603-528-5020

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  03606 , 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: 40597252 . This is a "HCBC" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com