MEDICARE: DR. PHILIP ADRIAN CARNEVALE M.D.

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	207L00000X	Anesthesiology Physician	ME63643	FL
2	207LP2900X	Pain Medicine (Anesthesiology) Physician	ME63643	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225105299
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PHILIP ADRIAN CARNEVALE M.D.

Provider Business Mailing Address
First Line	:	5105 BOWDEN RD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-5907
Country	:	US
Telephone Number	:	904-374-0260
Fax Number	:	904-619-5463

Provider Business Practice Location Address
First Line	:	5105 BOWDEN RD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-5907
Country	:	US
Telephone Number	:	904-374-0260
Fax Number	:	904-619-5463

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

Provider Enumeration Date	:	11/28/2006
Last Update Date	:	05/11/2012

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