MEDICARE: CRISTIAN CARBUCCIA

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	80551	GA

General Provider Information

NPI Number	:	1790167799
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRISTIAN CARBUCCIA

Provider Business Mailing Address
First Line	:	4422 THIRD AVE MILLS BLDG 3RD,
Second Line	:	DEPT OF INTERNAL MEDICINE
City	:	BRONX
State	:	NY
Zip	:	10457-2545
Country	:	US
Telephone Number	:	718-960-9000
Fax Number	:

Provider Business Practice Location Address
First Line	:	33 UPPER RIVERDALE RD SW STE 10
Second Line	:
City	:	RIVERDALE
State	:	GA
Zip	:	30274
Country	:	US
Telephone Number	:	770-897-7043
Fax Number	:

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

Provider Enumeration Date	:	06/25/2015
Last Update Date	:	05/12/2026

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Directions to “ CRISTIAN CARBUCCIA ” Practice Location

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