Provider Demographics
NPI:1831462159
Name:CELDARA MEDICAL LLC
Entity Type:Organization
Organization Name:CELDARA MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:YOLANDA
Authorized Official - Middle Name:CAMILLE
Authorized Official - Last Name:NESBETH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:603-236-1852
Mailing Address - Street 1:16 CAVENDISH CT
Mailing Address - Street 2:SUITE 240
Mailing Address - City:LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03766-1441
Mailing Address - Country:US
Mailing Address - Phone:617-320-8521
Mailing Address - Fax:617-475-5194
Practice Address - Street 1:16 CAVENDISH CT
Practice Address - Street 2:SUITE 240
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03766-1441
Practice Address - Country:US
Practice Address - Phone:617-320-8521
Practice Address - Fax:617-475-5194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-16
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH03680291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30809586Medicaid