Provider Demographics
NPI:1598741126
Name:CARNIVALE, BRUCE (DO)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:
Last Name:CARNIVALE
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 1:2450 W HUNTING PARK AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19129-1302
Mailing Address - Country:US
Mailing Address - Phone:215-707-3008
Mailing Address - Fax:215-707-1387
Practice Address - Street 1:3401 N BROAD ST
Practice Address - Street 2:7TH FLOOR OUT PATIENT BUILDING
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19140-5103
Practice Address - Country:US
Practice Address - Phone:215-707-3008
Practice Address - Fax:215-707-1387
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS 007278L207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA4476096OtherAETNA PPO
PA045941OtherHIGHMARK BLUE SHIELD
PA3122336OtherAETNA HMO
PA0678844OtherCIGNA
PA1016307OtherKEYSTONE MERCY HEALTH PLA
PA597586OtherMEDICARE GROUP TPI
PA0146198902OtherAMERICHOICE
PA001461989Medicaid
PA0717488000OtherINDEPENDENCE BLUE CROSS
PACD4829OtherRR MEDICARE TPI GROUPS
PAP00025012OtherRAIL ROAD MEDICARE
PA0678844OtherCIGNA
PA045941OtherHIGHMARK BLUE SHIELD