Healthcare Provider Details

I. General information

NPI: 1275575219
Provider Name (Legal Business Name): BARBARA S CIVIELLO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 07/10/2024
Certification Date: 07/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

789 CENTRAL AVENUE
DOVER NH
03820-2526
US

IV. Provider business mailing address

789 CENTRAL AVENUE
DOVER NH
03820-2526
US

V. Phone/Fax

Practice location:
  • Phone: 603-742-8787
  • Fax: 603-740-2446
Mailing address:
  • Phone: 603-742-8787
  • Fax: 603-740-2446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License Number12585
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number12585
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: