Provider Demographics
NPI:1245235571
Name:CARBONE, LAURA G (MD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:G
Last Name:CARBONE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:159 MARGARET ST
Mailing Address - Street 2:STE 600
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-1883
Mailing Address - Country:US
Mailing Address - Phone:518-563-2057
Mailing Address - Fax:518-563-2094
Practice Address - Street 1:159 MARGARET ST
Practice Address - Street 2:STE 600
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-1883
Practice Address - Country:US
Practice Address - Phone:518-563-2057
Practice Address - Fax:518-563-2094
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-14
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY163106-1207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01069992Medicaid
NYA61265Medicare UPIN
NY01069992Medicaid