Provider Demographics
NPI:1386615409
Name:SIROTY, WILLIAM C (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:C
Last Name:SIROTY
Suffix:
Gender:M
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:PO BOX 808
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03061-0808
Mailing Address - Country:US
Mailing Address - Phone:603-578-5054
Mailing Address - Fax:
Practice Address - Street 1:173 DANIEL WEBSTER HWY
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060-5224
Practice Address - Country:US
Practice Address - Phone:603-891-4400
Practice Address - Fax:603-891-4414
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH9230207R00000X, 207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH80003159Medicaid
NH80003159Medicaid
NHB17877Medicare UPIN