Provider Demographics
NPI:1174620363
Name:UPPER VALLEY NEUROLOGY NEUROSURGERY,PC
Entity type:Organization
Organization Name:UPPER VALLEY NEUROLOGY NEUROSURGERY,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:W
Authorized Official - Last Name:AYRES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:603-448-0447
Mailing Address - Street 1:106 HANOVER ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03766-1042
Mailing Address - Country:US
Mailing Address - Phone:603-448-0447
Mailing Address - Fax:603-448-1089
Practice Address - Street 1:106 HANOVER ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03766-1042
Practice Address - Country:US
Practice Address - Phone:603-448-0447
Practice Address - Fax:603-448-1089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH800003504Medicaid
NHRE3504Medicare ID - Type UnspecifiedGROUP PROVIDER NUMBER