Provider Demographics
NPI:1821168147
Name:CARBIN, RANDAL L (LMT)
Entity Type:Individual
Prefix:MR
First Name:RANDAL
Middle Name:L
Last Name:CARBIN
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1214 BERKLEY MANOR DR
Mailing Address - Street 2:
Mailing Address - City:CRANBERRY TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:16066-4865
Mailing Address - Country:US
Mailing Address - Phone:724-991-8153
Mailing Address - Fax:
Practice Address - Street 1:730 PARKWOOD DR
Practice Address - Street 2:
Practice Address - City:CRANBERRY TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:16066-6312
Practice Address - Country:US
Practice Address - Phone:724-991-8153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.014370174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist