Provider Demographics
NPI:1477733525
Name:CACCIATORE, JOSEPH CARMEN (MED, LATC)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:CARMEN
Last Name:CACCIATORE
Suffix:
Gender:M
Credentials:MED, LATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 TERRACE LN
Mailing Address - Street 2:
Mailing Address - City:EAST KINGSTON
Mailing Address - State:NH
Mailing Address - Zip Code:03827-2130
Mailing Address - Country:US
Mailing Address - Phone:603-560-2174
Mailing Address - Fax:
Practice Address - Street 1:85 MARSH RD
Practice Address - Street 2:
Practice Address - City:PELHAM
Practice Address - State:NH
Practice Address - Zip Code:03076-3134
Practice Address - Country:US
Practice Address - Phone:603-635-9652
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-06
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH03572255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer