Provider Demographics
NPI:1982724357
Name:LIDSTROM, CAROL FRANCES (MD)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:FRANCES
Last Name:LIDSTROM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CAROL
Other - Middle Name:FRANCES
Other - Last Name:WEISGERBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:105 WEST MAIN STREET
Mailing Address - Street 2:SUITE ONE
Mailing Address - City:LITTLETON
Mailing Address - State:NH
Mailing Address - Zip Code:03561
Mailing Address - Country:US
Mailing Address - Phone:603-444-0860
Mailing Address - Fax:
Practice Address - Street 1:105 WEST MAIN STREET
Practice Address - Street 2:SUITE ONE
Practice Address - City:LITTLETON
Practice Address - State:NH
Practice Address - Zip Code:03561
Practice Address - Country:US
Practice Address - Phone:603-444-0860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH76522084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
RE1387Medicare UPIN