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NPI Code Detail

MEDICARE: LYDIA B CAROLLO PA-C

MEDICARE: LYDIA B CAROLLO PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant24MA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1225015134
Entity Type Code : Individual
Provider Name (Legal Business Name) : LYDIA B CAROLLO PA-C
Provider Business Mailing Address
First Line : 197 ADAMS RD
Second Line :
City : WILLIAMSTOWN
State : MA
Zip : 01267-2930
Country : US
Telephone Number : 413-458-8182
Fax Number : 413-458-3140
Provider Business Practice Location Address
First Line : 197 ADAMS RD
Second Line :
City : WILLIAMSTOWN
State : MA
Zip : 01267-2930
Country : US
Telephone Number : 413-664-5900
Fax Number : 413-664-5767
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/30/2005
Last Update Date : 10/07/2011

Similar Medicare Providers

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Practice Location Address:
197 ADAMS RD
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01267-2930
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1225015282 — ALFRED J. WISE M.D.
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1881671832 — MICHAEL F. SUSSMAN M.D.
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1114904026 — EILEEN F. GABRIEL RN, GNP-C
Practice Location Address:
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1649468299 — WILLIAMSTOWN MEDICAL ASSOCIATES
Practice Location Address:
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1003185026 — MARGARET J SCOTT PA
Practice Location Address:
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Directions to “ LYDIA B CAROLLO PA-C” Practice Location

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