Healthcare Provider Details

I. General information

NPI: 1003353939
Provider Name (Legal Business Name): SALVATORE CARBONE MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2017
Last Update Date: 01/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 E BROAD ST ROOM 520
RICHMOND VA
23298-5058
US

IV. Provider business mailing address

2602 GROVE AVE APT 10
RICHMOND VA
23220-4344
US

V. Phone/Fax

Practice location:
  • Phone: 804-628-3980
  • Fax: 804-628-3984
Mailing address:
  • Phone: 804-503-7865
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number StateZZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: