MEDICARE: ANTONIO M. CARBONELL MD PA

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	261QA1903X	Ambulatory Surgical Clinic/Center	27897	NC

General Provider Information

NPI Number	:	1821271172
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANTONIO M. CARBONELL MD PA

Provider Business Mailing Address
First Line	:	215 N 35TH ST
Second Line	:
City	:	MOREHEAD CITY
State	:	NC
Zip	:	28557-3185
Country	:	US
Telephone Number	:	252-247-0094
Fax Number	:

Provider Business Practice Location Address
First Line	:	215 N 35TH ST
Second Line	:
City	:	MOREHEAD CITY
State	:	NC
Zip	:	28557-3185
Country	:	US
Telephone Number	:	252-247-0094
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ANTONIO MIGUEL CARBONELL
Credential	:	MD
Telephone Number	:	252-247-0094

Provider Enumeration Date	:	12/10/2007
Last Update Date	:	12/10/2007

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