Basic Information
| Provider Information | |||||||||
| NPI: | 1336319821 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MESSINA | ||||||||
| FirstName: | CARLEEN | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 65 CARRIAGE LN | ||||||||
| Address2: | |||||||||
| City: | BEDFORD | ||||||||
| State: | NH | ||||||||
| PostalCode: | 031104619 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8023451319 | ||||||||
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| Practice Location | |||||||||
| Address1: | 19 LEVESQUE DR | ||||||||
| Address2: | SUITE 2 | ||||||||
| City: | ELIOT | ||||||||
| State: | ME | ||||||||
| PostalCode: | 039032079 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2074519600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/11/2008 | ||||||||
| LastUpdateDate: | 02/13/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 10336 | NH | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 20001614 | 05 | NH | MEDICAID | P00874965 | 01 | NH | RAILROAD MEDICARE | OTHER |