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: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6021 WALLACE ROAD EXT STE 202
WEXFORD PA
15090-7399
US

IV. Provider business mailing address

6021 WALLACE ROAD EXT STE 202
WEXFORD PA
15090-7399
US

V. Phone/Fax

Practice location:
  • Phone: 724-799-8727
  • Fax: 724-799-8737
Mailing address:
  • Phone: 724-799-8727
  • Fax: 724-799-8737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: