Healthcare Provider Details

I. General information

NPI: 1407844319
Provider Name (Legal Business Name): CAROL FELISA ENCARNACION M.D., M.P.H.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2005
Last Update Date: 07/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

764 KENNEDY ST SUITE 101
MEADVILLE PA
16335-2209
US

IV. Provider business mailing address

1034 GROVE ST CBO
MEADVILLE PA
16335-2945
US

V. Phone/Fax

Practice location:
  • Phone: 814-373-2195
  • Fax: 814-373-2197
Mailing address:
  • Phone: 814-373-2923
  • Fax: 814-333-5640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberMD420301
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: