MEDICARE: MS. GINA M. CARBONARO PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AS0400X	Surgical Physician Assistant	C0002102	MD

General Provider Information

NPI Number	:	1003972027
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. GINA M. CARBONARO PA-C

Provider Business Mailing Address
First Line	:	831 UNIVERSITY BLVD E STE 36A
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20903-2915
Country	:	US
Telephone Number	:	301-408-2720
Fax Number	:

Provider Business Practice Location Address
First Line	:	831 UNIVERSITY BLVD E STE 36A
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20903-2915
Country	:	US
Telephone Number	:	301-408-2720
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/28/2006
Last Update Date	:	12/05/2019

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