Provider Demographics
NPI:1750815320
Name:NUNZIATO, CARL A (MD)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:A
Last Name:NUNZIATO
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:PSC 557 BOX 416
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96379-0005
Mailing Address - Country:US
Mailing Address - Phone:310-560-6609
Mailing Address - Fax:
Practice Address - Street 1:3D MEDICAL BATTALION
Practice Address - Street 2:UNIT 38445
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96373-8445
Practice Address - Country:US
Practice Address - Phone:315-645-4197
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-20
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR9410207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery