Provider Demographics
NPI:1003972027
Name:CARBONARO, GINA M (PA-C)
Entity Type:Individual
Prefix:MS
First Name:GINA
Middle Name:M
Last Name:CARBONARO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:831 UNIVERSITY BLVD E STE 36A
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20903-2915
Mailing Address - Country:US
Mailing Address - Phone:301-408-2720
Mailing Address - Fax:
Practice Address - Street 1:831 UNIVERSITY BLVD E STE 36A
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20903-2915
Practice Address - Country:US
Practice Address - Phone:301-408-2720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0002102363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical