Individual
DOUGLAS A DEAETT
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
125 MASCOMA ST, LEBANON, NH 03766-2647
(603) 448-3121
(603) 448-7462
Mailing address
125 MASCOMA ST, LEBANON, NH 03766-2647
(603) 448-3121
(603) 448-7462
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
5988
NH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1001226
—
VT
05
—
80000548
—
NH
Enumeration date
09/26/2005
Last updated
07/08/2007
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