# DERRY MEDICAL CENTER, PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1922030493
- **Authorized official:** TONYA LYN WILSON (BILLING/CREDENTIALING MANAGER)
- **Authorized official phone:** (603) 537-1317

## Contact information

- **Practice address:** 6 TSIENNETO RD, SUITE 100, DERRY, NH 03038-1584
- **Practice address phone:** (603) 537-1300
- **Practice address fax:** (603) 537-1326
- **Mailing address:** 14B TSIENNETO RD, DERRY, NH 03038-1560
- **Mailing address phone:** (603) 537-1300

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 133V00000X | Registered Dietitian | — | NULL | — |
| 133V00000X | Registered Dietitian | — | — | — |
| 207LP2900X | Pain Medicine (Anesthesiology) Physician | — | NULL | — |
| 207LP2900X | Pain Medicine (Anesthesiology) Physician | — | — | — |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 207QS0010X | Sports Medicine (Family Medicine) Physician | — | NULL | — |
| 207QS0010X | Sports Medicine (Family Medicine) Physician | — | — | — |
| 207RN0300X | Nephrology Physician | — | NULL | — |
| 207RN0300X | Nephrology Physician | — | — | — |

## Other

- **Enumeration date:** 07/07/2006
- **Last updated:** 04/15/2026

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 709488 | TUFTS | NH |
| 05 | — | 83019373 | — | NH |