Provider Demographics
NPI:1760432587
Name:CARBONE, KEVIN M (MSPT)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:M
Last Name:CARBONE
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5981 PUDDING STONE LN
Mailing Address - Street 2:
Mailing Address - City:BETHEL PARK
Mailing Address - State:PA
Mailing Address - Zip Code:15102-3335
Mailing Address - Country:US
Mailing Address - Phone:724-942-8990
Mailing Address - Fax:724-942-4461
Practice Address - Street 1:451 VALLEY BROOK RD
Practice Address - Street 2:
Practice Address - City:MC MURRAY
Practice Address - State:PA
Practice Address - Zip Code:15317-3353
Practice Address - Country:US
Practice Address - Phone:724-942-8990
Practice Address - Fax:724-942-4461
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT011758L208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation