Provider Demographics
NPI:1871786442
Name:WOMEN'S HEALTH ASSOCIATES OF PORTSMOUTH PA
Entity type:Organization
Organization Name:WOMEN'S HEALTH ASSOCIATES OF PORTSMOUTH PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:M
Authorized Official - Last Name:ETHIER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:603-436-1128
Mailing Address - Street 1:875 GREENLAND RD
Mailing Address - Street 2:BUILDING A-1
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-4164
Mailing Address - Country:US
Mailing Address - Phone:603-436-1128
Mailing Address - Fax:603-431-4537
Practice Address - Street 1:875 GREENLAND RD
Practice Address - Street 2:BUILDING A-1
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-4164
Practice Address - Country:US
Practice Address - Phone:603-436-1128
Practice Address - Fax:603-431-4537
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-27
Last Update Date:2010-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30002461Medicaid
NH30002461Medicaid