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NPI Code Detail

MEDICARE: MARIO E CARBONELL MD

MEDICARE: MARIO E CARBONELL 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
1207R00000XInternal Medicine PhysicianME0065067FL

Other Identifiers

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

General Provider Information

NPI Number : 1639150048
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARIO E CARBONELL MD
Provider Business Mailing Address
First Line : 17912 TOLEDO BLADE BLVD STE A
Second Line :
City : PORT CHARLOTTE
State : FL
Zip : 33948-1042
Country : US
Telephone Number : 941-766-1001
Fax Number : 941-766-1830
Provider Business Practice Location Address
First Line : 17912 TOLEDO BLADE BLVD STE A
Second Line :
City : PORT CHARLOTTE
State : FL
Zip : 33948-1042
Country : US
Telephone Number : 941-766-1001
Fax Number : 941-766-1830
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/11/2005
Last Update Date : 05/18/2012

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Directions to “ MARIO E CARBONELL MD” Practice Location

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