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General NPI Number Information
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NPI Number | 1760679567
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Entity Type | Organization
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Legal Business Name | GINA M CARLO DPM PC
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Dates
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Enumeration Date | 09/26/2007
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Last Update Date | 05/12/2009
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Provider Practice Location Address
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Address Line | 26 N SCOTT ST
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City | CARBONDALE
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State | PA
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Zip | 18407-1834
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Country | US
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Telephone | 570-282-0900
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Fax | 570-282-7519
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Provider Business Mailing Address
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Address Line | 120 UPLAND TER
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City | CLARKS SUMMIT
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State | PA
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Zip | 18411-8982
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Country | US
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Telephone | 570-282-0900
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Fax | 570-282-7519
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Authorized Official
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Title or Position | PODIATRIST
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Name | GINA CARLO
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Credential | DPM
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Telephone | 570-282-0900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213EP1101X
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Taxonomy Name | Primary Podiatric Medicine Podiatrist
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License Number | SC003210L
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License Number State | PA
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