Provider Demographics
NPI:1679693857
Name:GARRY M CARBONE MD PC
Entity type:Organization
Organization Name:GARRY M CARBONE MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:GARRY
Authorized Official - Middle Name:M
Authorized Official - Last Name:CARBONE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-379-4740
Mailing Address - Street 1:179 DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:PALMERTON
Mailing Address - State:PA
Mailing Address - Zip Code:18071-1728
Mailing Address - Country:US
Mailing Address - Phone:610-379-4740
Mailing Address - Fax:610-379-4745
Practice Address - Street 1:179 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:PALMERTON
Practice Address - State:PA
Practice Address - Zip Code:18071-1728
Practice Address - Country:US
Practice Address - Phone:610-379-4740
Practice Address - Fax:610-379-4745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD043165L207RN0300X
261QM0801X, 261QM1300X, 261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA02867700OtherCAPITAL BLUE CROSS
PA110108413OtherPALMETTO GBA
110108413OtherPALMETTO GBA
PA710518OtherHIGHMARK BLUE SHIELD
PA0012379820010Medicaid
PAF16780OtherUPIN
PA710518Medicare PIN