Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | NH 8396 | NH |
Y | 207QA0401X | Family Doctor - Addiction Medicine | 8396 | NH |
NPI | 1326245747 |
---|---|
Provider Name | Roland A. Lavallee |
First Address | Bedford, NH 03110-5014 |
Second Address | Manchester, NH 03103-7122 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2007 |
Last Update Date | 21/05/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
30003649 | (05) | NH |
E68454 | (02) | NH |