Healthcare Provider Details

I. General information

NPI: 1851416606
Provider Name (Legal Business Name): WILLIAM THOMAS DECARBO DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 03/30/2021
Certification Date: 12/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 PLAZA DR SUITE 240
BELLE VERNON PA
15012-4019
US

IV. Provider business mailing address

1000 BOWER HILL ROAD ATTN PAMALYN AFFILIATE BILLING
PITTSBURGH PA
15243-1873
US

V. Phone/Fax

Practice location:
  • Phone: 724-379-5816
  • Fax: 724-379-5874
Mailing address:
  • Phone: 412-942-2548
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberSC006180
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number36003450
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: