MEDICARE: CARL E EBY 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	207Q00000X	Family Medicine Physician	MD044330E	PA

General Provider Information

NPI Number	:	1912986605
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARL E EBY MD

Provider Business Mailing Address
First Line	:	991 ROUTE 19 N STE B
Second Line	:
City	:	WATERFORD
State	:	PA
Zip	:	16441-9739
Country	:	US
Telephone Number	:	814-877-8790
Fax Number	:	814-796-4238

Provider Business Practice Location Address
First Line	:	991 ROUTE 19 N STE B
Second Line	:
City	:	WATERFORD
State	:	PA
Zip	:	16441-9739
Country	:	US
Telephone Number	:	814-877-8790
Fax Number	:	814-796-4238

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

Provider Enumeration Date	:	01/11/2006
Last Update Date	:	04/27/2020

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Directions to “ CARL E EBY MD” Practice Location

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