Healthcare Provider Details

I. General information

NPI: 1346248291
Provider Name (Legal Business Name): CHRISTOPHER JOHN CARBO DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 02/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5515 PEACH ST
ERIE PA
16509-2603
US

IV. Provider business mailing address

PO BOX 9471
ERIE PA
16505-8471
US

V. Phone/Fax

Practice location:
  • Phone: 814-868-8252
  • Fax: 814-868-8170
Mailing address:
  • Phone: 814-868-8252
  • Fax: 814-868-8170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberOS010329L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS010329L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: