Provider Demographics
NPI:1679521884
Name:OGRADY, DENISE M (MD)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:M
Last Name:OGRADY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 FRONT ST # 42
Mailing Address - Street 2:
Mailing Address - City:EXETER
Mailing Address - State:NH
Mailing Address - Zip Code:03833-2329
Mailing Address - Country:US
Mailing Address - Phone:603-553-7078
Mailing Address - Fax:
Practice Address - Street 1:150 FRONT ST # 42
Practice Address - Street 2:
Practice Address - City:EXETER
Practice Address - State:NH
Practice Address - Zip Code:03833-2329
Practice Address - Country:US
Practice Address - Phone:603-553-7078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH9741208000000X
NMMD2008-0605208000000X
WI53672208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30009737Medicaid
NH30009737Medicaid
NHRE7675Medicare ID - Type Unspecified