Healthcare Provider Details

I. General information

NPI: 1679693857
Provider Name (Legal Business Name): GARRY M CARBONE MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 03/13/2023
Certification Date: 03/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

179 DELAWARE AVE
PALMERTON PA
18071-1728
US

IV. Provider business mailing address

179 DELAWARE AVE
PALMERTON PA
18071-1728
US

V. Phone/Fax

Practice location:
  • Phone: 610-379-4740
  • Fax: 610-379-4745
Mailing address:
  • Phone: 610-379-4740
  • Fax: 610-379-4745

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberMD043165L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GARRY M CARBONE
Title or Position: OWNER PROVIDER
Credential: MD
Phone: 610-379-4740