Provider Demographics
NPI:1255859757
Name:BIBA, CAROLYN JAMIE (PA)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:JAMIE
Last Name:BIBA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 GRIFFIN RD
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-2093
Mailing Address - Country:US
Mailing Address - Phone:603-431-6011
Mailing Address - Fax:
Practice Address - Street 1:155 GRIFFIN RD
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-2093
Practice Address - Country:US
Practice Address - Phone:603-431-6011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-05
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant