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General NPI Number Information
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NPI Number | 1083864474
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Entity Type | Organization
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Legal Business Name | MARIO E CARBONELL MD PA
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Dates
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Enumeration Date | 09/23/2008
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Last Update Date | 11/12/2013
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Provider Practice Location Address
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Address Line | 17912 TOLDEO BLADE BLVD STE A
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City | PORT CHARLOTTE
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State | FL
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Zip | 33948-1042
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Country | US
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Telephone | 941-766-1001
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Fax | 941-766-1830
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Provider Business Mailing Address
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Address Line | 17912 TOLDEO BLADE BLVD STE A
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City | PORT CHARLOTTE
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State | FL
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Zip | 33948-1042
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Country | US
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Telephone | 941-766-1001
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Fax | 941-766-1830
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARIO E CARBONELL
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Credential | MD PA
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Telephone | 941-766-1001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME0065067
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License Number State | FL
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