Healthcare Provider Details

I. General information

NPI: 1962061663
Provider Name (Legal Business Name): CALEB ROBERT HOWARD PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2019
Last Update Date: 05/18/2023
Certification Date: 05/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

252 BROAD ST
CLAREMONT NH
03743-2636
US

IV. Provider business mailing address

252 BROAD ST
CLAREMONT NH
03743-2636
US

V. Phone/Fax

Practice location:
  • Phone: 603-542-6455
  • Fax: 603-543-0736
Mailing address:
  • Phone: 603-542-6455
  • Fax: 603-543-0736

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1644
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number005.0031527
License Number StateVT
# 3
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number1644
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: