Provider Demographics
NPI:1184633653
Name:GIOMBETTI, CARL (MD)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:
Last Name:GIOMBETTI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 HAVERFORD RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HAVERFORD
Mailing Address - State:PA
Mailing Address - Zip Code:19041
Mailing Address - Country:US
Mailing Address - Phone:610-658-0999
Mailing Address - Fax:215-590-3056
Practice Address - Street 1:600 HAVERFORD RD
Practice Address - Street 2:SUITE 100
Practice Address - City:HAVERFORD
Practice Address - State:PA
Practice Address - Zip Code:19041
Practice Address - Country:US
Practice Address - Phone:610-658-0999
Practice Address - Fax:215-590-3056
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS-005236-L208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAB31294Medicare UPIN
PA007875Medicare ID - Type Unspecified