MEDICARE: GINA M CARLO DPM PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213EP1101X	Primary Podiatric Medicine Podiatrist	SC003210L	PA

General Provider Information

NPI Number	:	1760679567
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GINA M CARLO DPM PC

Provider Business Mailing Address
First Line	:	120 UPLAND TER
Second Line	:
City	:	CLARKS SUMMIT
State	:	PA
Zip	:	18411-8982
Country	:	US
Telephone Number	:	570-282-0900
Fax Number	:	570-282-7519

Provider Business Practice Location Address
First Line	:	26 N SCOTT ST
Second Line	:
City	:	CARBONDALE
State	:	PA
Zip	:	18407-1834
Country	:	US
Telephone Number	:	570-282-0900
Fax Number	:	570-282-7519

Authorized Official
Title or Position	:	PODIATRIST
Name	:	GINA CARLO
Credential	:	DPM
Telephone Number	:	570-282-0900

Provider Enumeration Date	:	09/26/2007
Last Update Date	:	05/12/2009

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