=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407844319
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CAROL FELISA ENCARNACION M.D., M.P.H.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/13/2005
-----------------------------------------------------
Last Update Date | 07/01/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 764 KENNEDY ST SUITE 101
-----------------------------------------------------
City | MEADVILLE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16335-2209
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-373-2195
-----------------------------------------------------
Fax | 814-373-2197
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1034 GROVE ST CBO
-----------------------------------------------------
City | MEADVILLE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16335-2945
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-373-2923
-----------------------------------------------------
Fax | 814-333-5640
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RI0200X
-----------------------------------------------------
Taxonomy Name | Infectious Disease Physician
-----------------------------------------------------
License Number | MD420301
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------