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General NPI Number Information
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NPI Number | 1477733525
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Entity Type | Individual
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Provider Name | JOSEPH CARMEN CACCIATORE MED, LATC
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Gender | Male
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Dates
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Enumeration Date | 11/06/2007
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Last Update Date | 11/06/2007
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Provider Practice Location Address
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Address Line | 85 MARSH RD
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City | PELHAM
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State | NH
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Zip | 03076-3134
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Country | US
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Telephone | 603-635-9652
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Fax |
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Provider Business Mailing Address
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Address Line | 1 TERRACE LN
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City | EAST KINGSTON
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State | NH
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Zip | 03827-2130
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Country | US
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Telephone | 603-560-2174
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 0357
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License Number State | NH
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