Provider Demographics
NPI:1275770265
Name:RODRIGUEZ CARABALLO, GLADYS V (PA-C)
Entity Type:Individual
Prefix:
First Name:GLADYS
Middle Name:V
Last Name:RODRIGUEZ CARABALLO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEWMARKET
Mailing Address - State:NH
Mailing Address - Zip Code:03857-1835
Mailing Address - Country:US
Mailing Address - Phone:603-292-3061
Mailing Address - Fax:603-659-5892
Practice Address - Street 1:207 S MAIN ST
Practice Address - Street 2:
Practice Address - City:NEWMARKET
Practice Address - State:NH
Practice Address - Zip Code:03857-1835
Practice Address - Country:US
Practice Address - Phone:603-292-7292
Practice Address - Fax:603-659-5892
Is Sole Proprietor?:No
Enumeration Date:2009-01-13
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1020363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3096848Medicaid
VT9001140Medicaid