Provider Demographics
NPI:1821060203
Name:KLONEL, CARRIE B (DO)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:B
Last Name:KLONEL
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 1:12 ELM ST
Mailing Address - Street 2:
Mailing Address - City:ANTRIM
Mailing Address - State:NH
Mailing Address - Zip Code:03440-3916
Mailing Address - Country:US
Mailing Address - Phone:603-588-4200
Mailing Address - Fax:603-588-4089
Practice Address - Street 1:12 ELM ST
Practice Address - Street 2:
Practice Address - City:ANTRIM
Practice Address - State:NH
Practice Address - Zip Code:03440-3916
Practice Address - Country:US
Practice Address - Phone:603-588-4200
Practice Address - Fax:603-588-4089
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH12795207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30212207Medicaid
NH30212207Medicaid
NHRE8359Medicare ID - Type Unspecified