Provider Demographics
NPI:1700878642
Name:MESSERE, CAROLYN BETH (MD)
Entity Type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:BETH
Last Name:MESSERE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CAROLYN
Other - Middle Name:BETH
Other - Last Name:CIRELLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4280 TAMIAMI TRL E STE 102
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34112-6705
Mailing Address - Country:US
Mailing Address - Phone:239-774-5433
Mailing Address - Fax:239-774-5409
Practice Address - Street 1:4280 TAMIAMI TRL E STE 102
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34112-6705
Practice Address - Country:US
Practice Address - Phone:239-774-5433
Practice Address - Fax:239-774-5409
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-17
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME93472208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL273556300Medicaid
FL273556300Medicaid
FL16596XMedicare PIN