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General NPI Number Information
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NPI Number | 1275639783
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Entity Type | Individual
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Provider Name | RICARDO CARABALLO MD
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Gender | Male
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Dates
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Enumeration Date | 09/15/2006
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Last Update Date | 07/25/2016
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Provider Practice Location Address
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Address Line | 6012 MAIN STREET
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City | VOORHEES
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State | NJ
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Zip | 08043
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Country | US
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Telephone | 856-325-6622
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Fax | 856-325-6522
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Provider Business Mailing Address
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Address Line | PO BOX 416457
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City | BOSTON
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State | MA
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Zip | 02241-6457
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Country | US
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Telephone | 973-656-6280
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Fax | 973-290-7495
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 25MA06319600
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 207VF0040X
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Taxonomy Name | Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
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License Number | NJMA63196
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License Number State | NJ
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