Provider Demographics
NPI:1194086587
Name:COCHECO NEUROLOGY PLLC
Entity type:Organization
Organization Name:COCHECO NEUROLOGY PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:KISHORI
Authorized Official - Middle Name:
Authorized Official - Last Name:SOMYREDDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:603-583-1458
Mailing Address - Street 1:37 MALLARD LN
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-5016
Mailing Address - Country:US
Mailing Address - Phone:603-583-1458
Mailing Address - Fax:
Practice Address - Street 1:750 CENTRAL AVE
Practice Address - Street 2:SUITE B
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-3434
Practice Address - Country:US
Practice Address - Phone:603-583-1458
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-02
Last Update Date:2012-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH14852261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty