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General NPI Number Information
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NPI Number | 1033734447
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Entity Type | Individual
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Provider Name | KAREN MICHELLE CUSTODIO DO
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Gender | Female
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Dates
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Enumeration Date | 06/11/2020
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Last Update Date | 10/16/2025
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Provider Practice Location Address
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Address Line | 111 COLCHESTER AVE
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City | BURLINGTON
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State | VT
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Zip | 05401-1473
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Country | US
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Telephone | 802-847-0000
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Fax |
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Provider Business Mailing Address
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Address Line | 1 MEDICAL CENTER DR
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City | LEBANON
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State | NH
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Zip | 03756-0001
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QH0002X
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Taxonomy Name | Hospice and Palliative Medicine (Family Medicine) Physician
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License Number | 032.0134274
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License Number State | VT
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 032.0134274
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License Number State | VT
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Taxonomy #3
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | OT019969
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License Number State | PA
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Taxonomy #4
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 338635
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License Number State | NY
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Taxonomy #5
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | R4289
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License Number State | NH
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