Provider Demographics
NPI:1457315210
Name:E DUANE CARMALT MD INC.
Entity Type:Organization
Organization Name:E DUANE CARMALT MD INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:E DUANE
Authorized Official - Middle Name:
Authorized Official - Last Name:CARMALT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-881-9255
Mailing Address - Street 1:5620 WILBUR AVE
Mailing Address - Street 2:SUITE 307
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356
Mailing Address - Country:US
Mailing Address - Phone:818-881-9255
Mailing Address - Fax:818-881-3397
Practice Address - Street 1:5620 WILBUR AVE
Practice Address - Street 2:SUITE 307
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356
Practice Address - Country:US
Practice Address - Phone:818-881-9255
Practice Address - Fax:818-881-3397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-17
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWG23973AMedicare PIN
CAW21191Medicare PIN