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NPI Code Detail

MEDICARE: DR. GREGORY M CARBONE D.O.

MEDICARE: DR. GREGORY M CARBONE D.O.
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
1174400000XSpecialist056692GA
22085R0202XDiagnostic Radiology Physician200300010NC
32085R0202XDiagnostic Radiology Physician735SC
42085R0202XDiagnostic Radiology Physician0102201824VA
52085B0100XBody Imaging Physician200300010NC

General Provider Information

NPI Number : 1902894629
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GREGORY M CARBONE D.O.
Provider Business Mailing Address
First Line : 4801 VETERANS DR
Second Line :
City : SAINT CLOUD
State : MN
Zip : 56303-2015
Country : US
Telephone Number : 320-255-6480
Fax Number :
Provider Business Practice Location Address
First Line : 4801 VETERANS DR
Second Line :
City : SAINT CLOUD
State : MN
Zip : 56303-2015
Country : US
Telephone Number : 320-255-6480
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/06/2005
Last Update Date : 09/15/2025

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