Basic Information
Provider Information
NPI: 1184633646
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: VARDO
FirstName: JOYCELYN
MiddleName: HELENE
NamePrefix: DR.
NameSuffix:  
Credential: DO
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 44 BELANGER DR
Address2:  
City: DOVER
State: NH
PostalCode: 038204602
CountryCode: US
TelephoneNumber: 2076537118
FaxNumber:  
Practice Location
Address1: 700 CENTRAL AVE
Address2:  
City: DOVER
State: NH
PostalCode: 038206434
CountryCode: US
TelephoneNumber: 6037422424
FaxNumber:  
Other Information
ProviderEnumerationDate: 08/05/2006
LastUpdateDate: 06/28/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207V00000X242484MAY Allopathic & Osteopathic PhysiciansObstetrics & Gynecology 

No ID Information.


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