Provider Demographics
NPI:1376524595
Name:HASKELL, CAROLYN (DO)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:HASKELL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 BOULDER POINT DR STE 1
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03264-3170
Mailing Address - Country:US
Mailing Address - Phone:603-536-4000
Mailing Address - Fax:603-536-4001
Practice Address - Street 1:101 BOULDER POINT DR STE 1
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03264-3170
Practice Address - Country:US
Practice Address - Phone:603-536-4000
Practice Address - Fax:603-536-4001
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-07
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA202775207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F64624Medicare UPIN