| Mario E Carbonell MD PA | |
|
17912 Toldeo Blade Blvd Ste A Port Charlotte FL 33948-1042 | |
| (941) 766-1001 | |
| (941) 766-1830 |
| Full Name | Mario E Carbonell MD PA |
|---|---|
| Speciality | Internal Medicine |
| Location | 17912 Toldeo Blade Blvd Ste A, Port Charlotte, Florida |
| Authorized Official Name and Position | Mario E Carbonell (OWNER) |
| Authorized Official Contact | 9417661001 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mario E Carbonell MD PA 17912 Toldeo Blade Blvd Ste A Port Charlotte FL 33948-1042 Ph: (941) 766-1001 | Mario E Carbonell MD PA 17912 Toldeo Blade Blvd Ste A Port Charlotte FL 33948-1042 Ph: (941) 766-1001 |
| NPI Number | 1083864474 |
|---|---|
| Provider Enumeration Date | 09/23/2008 |
| Last Update Date | 11/12/2013 |
| Medicare PECOS PAC ID | 2163586868 |
|---|---|
| Medicare Enrollment ID | O20090124000071 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083864474 | NPI | - | NPPES |
| 375926100 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | ME0065067 (Florida) | Primary |
| Provider Name | Mario E Carbonell |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1639150048 PECOS PAC ID: 5890861421 Enrollment ID: I20080905000416 |
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