Provider Demographics
NPI:1326075482
Name:COLOMBO, CARL SAMUEL (DO)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:SAMUEL
Last Name:COLOMBO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 6TH AVE STE 114
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403-2627
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1600 6TH AVE
Practice Address - Street 2:SUITE 114
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-2627
Practice Address - Country:US
Practice Address - Phone:717-755-1244
Practice Address - Fax:717-757-7644
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2021-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS006429E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102765650Medicaid
PA102765650Medicaid
PA461826Medicare ID - Type Unspecified