Provider Demographics
NPI:1275639783
Name:CARABALLO, RICARDO (MD)
Entity Type:Individual
Prefix:
First Name:RICARDO
Middle Name:
Last Name:CARABALLO
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:PO BOX 416457
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-6457
Mailing Address - Country:US
Mailing Address - Phone:973-656-6280
Mailing Address - Fax:973-290-7495
Practice Address - Street 1:6012 MAIN STREET
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043
Practice Address - Country:US
Practice Address - Phone:856-325-6622
Practice Address - Fax:856-325-6522
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06319600207V00000X
NJNJMA63196207VF0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyFemale Pelvic Medicine and Reconstructive Surgery
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2207042/7597015OtherAETNA
NJP2704813OtherOXFORD
NJ7780702Medicaid
NJ3K7732OtherHEALTHNET
NJ0094687000OtherAMERIHEALTH/KEYSTONE/IBC
NJ010003742OtherAMERICHOICE
NJ1105869OtherHORIZON NJ HEALTH
NJ1949172OtherUNITED HEALTHCARE
NJ24212OtherUNIVERSITY HEALTH PLAN
NJ9402184OtherCIGNA
NJ023143PXQMedicare PIN
NJ0094687000OtherAMERIHEALTH/KEYSTONE/IBC
NJP2704813OtherOXFORD
NJ010003742OtherAMERICHOICE
NJ1949172OtherUNITED HEALTHCARE