Provider Demographics
NPI:1124040985
Name:CARNVALE, EDWARD MICHAEL (DPM)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:MICHAEL
Last Name:CARNVALE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1002 BRODHEAD RD
Mailing Address - Street 2:
Mailing Address - City:MOON TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:15108
Mailing Address - Country:US
Mailing Address - Phone:412-262-3003
Mailing Address - Fax:412-269-7785
Practice Address - Street 1:1002 BRODHEAD RD
Practice Address - Street 2:
Practice Address - City:MOON TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:15108
Practice Address - Country:US
Practice Address - Phone:412-262-3003
Practice Address - Fax:412-269-7785
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC002701L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1010736Medicaid
PA154863Medicare PIN
PA1010736Medicaid