Healthcare Provider Details

I. General information

NPI: 1740690163
Provider Name (Legal Business Name): MICHELLE CIARLO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2014
Last Update Date: 04/01/2024
Certification Date: 03/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

246 PLEASANT ST BLDG WEST
CONCORD NH
03301-2548
US

IV. Provider business mailing address

250 PLEASANT ST MEDICAL STAFF SERVICES
CONCORD NH
03301
US

V. Phone/Fax

Practice location:
  • Phone: 36-228-1111
  • Fax: 603-227-7558
Mailing address:
  • Phone: 603-227-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberP11-00454
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number16783
License Number StateNH
# 3
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number16783
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: