Basic Information
| Provider Information | |||||||||
| NPI: | 1528192986 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BACHELDER | ||||||||
| FirstName: | SHEILLA | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 125 MASCOMA ST | ||||||||
| Address2: | |||||||||
| City: | LEBANON | ||||||||
| State: | NH | ||||||||
| PostalCode: | 037662647 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6034483121 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 123 MASCOMA ST | ||||||||
| Address2: | PHYSICIAN PRACTICES AT ALICE PECK DAY MEMORIAL HOSPITAL | ||||||||
| City: | LEBANON | ||||||||
| State: | NH | ||||||||
| PostalCode: | 037662647 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6034483121 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/15/2007 | ||||||||
| LastUpdateDate: | 03/11/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | BF4323200CW | VT | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207Q00000X | 14485 | NH | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 020222791 | 01 | CBA | OTHER | 1528192986 | 01 | NH | ANTHEM | OTHER | AA155016 | 01 | HARVARD PILGRIM | OTHER | 020222791 | 01 | GREAT WEST | OTHER | 3009866 | 01 | MVP | OTHER | 30208961 | 05 | NH | MEDICAID | 020222791 | 01 | INTEGRATED HEALTH | OTHER | 1016686 | 05 | VT | MEDICAID | 020222791 | 01 | CIGNA | OTHER | 1528192986 | 01 | VT | BCBS OF VT | OTHER | 020222791 | 01 | MULTIPLAN | OTHER |