Provider Demographics
NPI:1225105299
Name:CARNEVALE, PHILIP ADRIAN (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:ADRIAN
Last Name:CARNEVALE
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 1:5105 BOWDEN RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-5907
Mailing Address - Country:US
Mailing Address - Phone:904-374-0260
Mailing Address - Fax:904-619-5463
Practice Address - Street 1:5105 BOWDEN RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-5907
Practice Address - Country:US
Practice Address - Phone:904-374-0260
Practice Address - Fax:904-619-5463
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2012-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME63643207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL372464601Medicaid
FL372464601Medicaid