Provider Demographics
NPI:1447212006
Name:CARBONE, RALPH F JR (DO)
Entity Type:Individual
Prefix:
First Name:RALPH
Middle Name:F
Last Name:CARBONE
Suffix:JR
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 1:212 W EDISON RD
Mailing Address - Street 2:SUITE F
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46545-8301
Mailing Address - Country:US
Mailing Address - Phone:574-257-0621
Mailing Address - Fax:574-257-0641
Practice Address - Street 1:212 W EDISON RD STE F
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-8301
Practice Address - Country:US
Practice Address - Phone:574-257-0621
Practice Address - Fax:574-257-0641
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02001120A207LP2900X
IN02001120208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200540580Medicaid
INE83164Medicare UPIN
IN166970Medicare PIN