=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225533573
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MICHELE FRANCES CARAVELLA MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/28/2018
-----------------------------------------------------
Last Update Date | 09/19/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 121 PEMBROKE ST
-----------------------------------------------------
City | PEMBROKE
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03275-1311
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-485-8441
-----------------------------------------------------
Fax | 603-227-7563
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 121 PEMBROKE ST.
-----------------------------------------------------
City | PEMBROKE
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03275
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-485-8441
-----------------------------------------------------
Fax | 603-227-7563
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 390200000X
-----------------------------------------------------
Taxonomy Name | Student in an Organized Health Care Education/Training Program
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 23081
-----------------------------------------------------
License Number State | NH
-----------------------------------------------------