Provider Demographics
NPI:1851416606
Name:DECARBO, WILLIAM THOMAS (DPM)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:THOMAS
Last Name:DECARBO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 BOWER HILL ROAD
Mailing Address - Street 2:ATTN PAMALYN AFFILIATE BILLING
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15243-1873
Mailing Address - Country:US
Mailing Address - Phone:412-942-2548
Mailing Address - Fax:
Practice Address - Street 1:800 PLAZA DR
Practice Address - Street 2:SUITE 240
Practice Address - City:BELLE VERNON
Practice Address - State:PA
Practice Address - Zip Code:15012-4019
Practice Address - Country:US
Practice Address - Phone:724-379-5816
Practice Address - Fax:724-379-5874
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC006180213ES0103X
OH36003450213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1025374200001Medicaid
OH2731299Medicaid
OH2731299Medicaid
OH4204921Medicare PIN
V11874Medicare UPIN