Healthcare Provider Details

I. General information

NPI: 1487247722
Provider Name (Legal Business Name): CARBON HEALTH MEDICAL GROUP OF FLORIDA PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2021
Last Update Date: 06/25/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 HAVEMEYER ST
BROOKLYN NY
11211-3340
US

IV. Provider business mailing address

2100 FRANKLIN ST STE 355
OAKLAND CA
94612-3140
US

V. Phone/Fax

Practice location:
  • Phone: 415-200-2099
  • Fax: 888-972-1912
Mailing address:
  • Phone:
  • Fax: 888-972-1912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MARLEY PAGE
Title or Position: DIRECTOR
Credential:
Phone: 417-861-9739