Provider Demographics
NPI:1154555746
Name:DEAL, MARY R (MD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:R
Last Name:DEAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:RIDDELL
Other - Last Name:DEAL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:22 WHITE ST
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-4176
Mailing Address - Country:US
Mailing Address - Phone:603-225-0201
Mailing Address - Fax:
Practice Address - Street 1:22 WHITE ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-4176
Practice Address - Country:US
Practice Address - Phone:603-225-0201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-11
Last Update Date:2009-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY143684207Q00000X
NH14339207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine