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General NPI Number Information
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NPI Number | 1679693857
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Entity Type | Organization
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Legal Business Name | GARRY M CARBONE MD PC
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Dates
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Enumeration Date | 03/30/2007
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Last Update Date | 03/13/2023
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Provider Practice Location Address
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Address Line | 179 DELAWARE AVE
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City | PALMERTON
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State | PA
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Zip | 18071-1728
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Country | US
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Telephone | 610-379-4740
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Fax | 610-379-4745
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Provider Business Mailing Address
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Address Line | 179 DELAWARE AVE
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City | PALMERTON
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State | PA
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Zip | 18071-1728
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Country | US
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Telephone | 610-379-4740
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Fax | 610-379-4745
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Authorized Official
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Title or Position | OWNER PROVIDER
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Name | GARRY M CARBONE
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Credential | MD
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Telephone | 610-379-4740
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | MD043165L
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License Number State | PA
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