Provider Demographics
NPI:1891869723
Name:CARBONELL, ANTONIO MIGUEL (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTONIO
Middle Name:MIGUEL
Last Name:CARBONELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:215 N 35TH ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MOREHEAD CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28557-3103
Mailing Address - Country:US
Mailing Address - Phone:252-247-0094
Mailing Address - Fax:252-247-9285
Practice Address - Street 1:215 N 35TH ST
Practice Address - Street 2:SUITE 1
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557-3103
Practice Address - Country:US
Practice Address - Phone:252-247-0094
Practice Address - Fax:252-247-9285
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC27897208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC21097OtherBCBS EDS IP NUMBER
NC21097OtherBCBS EDS IP NUMBER