Provider Demographics
NPI:1336319821
Name:MESSINA, CARLEEN (DO)
Entity Type:Individual
Prefix:
First Name:CARLEEN
Middle Name:
Last Name:MESSINA
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 1:65 CARRIAGE LN
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110-4619
Mailing Address - Country:US
Mailing Address - Phone:802-345-1319
Mailing Address - Fax:
Practice Address - Street 1:19 LEVESQUE DR
Practice Address - Street 2:SUITE 2
Practice Address - City:ELIOT
Practice Address - State:ME
Practice Address - Zip Code:03903-2079
Practice Address - Country:US
Practice Address - Phone:207-451-9600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-11
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH10336207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH20001614Medicaid
NHP00874965OtherRAILROAD MEDICARE
NHVN188502Medicare PIN