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General NPI Number Information
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NPI Number | 1831462159
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Entity Type | Organization
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Legal Business Name | CELDARA MEDICAL LLC
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Dates
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Enumeration Date | 02/16/2012
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Last Update Date | 10/01/2012
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Provider Practice Location Address
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Address Line | 16 CAVENDISH CT SUITE 240
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City | LEBANON
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State | NH
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Zip | 03766-1441
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Country | US
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Telephone | 617-320-8521
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Fax | 617-475-5194
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Provider Business Mailing Address
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Address Line | 16 CAVENDISH CT SUITE 240
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City | LEBANON
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State | NH
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Zip | 03766-1441
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Country | US
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Telephone | 617-320-8521
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Fax | 617-475-5194
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Authorized Official
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Title or Position | OPERATIONS MANAGER
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Name | DR. YOLANDA CAMILLE NESBETH
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Credential | PH.D.
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Telephone | 603-236-1852
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 03680
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License Number State | NH
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