MEDICARE: DR. FERNANDO C. CARNAVALI MD

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	207R00000X	Internal Medicine Physician	212264	NY

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	:	1235210105
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FERNANDO C. CARNAVALI MD

Provider Business Mailing Address
First Line	:	150 E 42ND ST FL 9
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10017-5699
Country	:	US
Telephone Number	:	646-605-8186
Fax Number	:

Provider Business Practice Location Address
First Line	:	2109 BROADWAY
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10023-2138
Country	:	US
Telephone Number	:	212-492-5500
Fax Number	:

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

Provider Enumeration Date	:	10/18/2006
Last Update Date	:	04/21/2021

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