Provider Demographics
NPI:1326886920
Name:TROUT, CARMEN MARIA
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:MARIA
Last Name:TROUT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:443 PLACE LN
Mailing Address - Street 2:
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-2978
Mailing Address - Country:US
Mailing Address - Phone:617-932-9337
Mailing Address - Fax:
Practice Address - Street 1:4905 TUSCARORA RD
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14304-1164
Practice Address - Country:US
Practice Address - Phone:617-932-9337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-17
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program