Provider Demographics
NPI:1942318449
Name:CARBONE, PAULA JO (MD,MBA)
Entity Type:Individual
Prefix:DR
First Name:PAULA JO
Middle Name:
Last Name:CARBONE
Suffix:
Gender:F
Credentials:MD,MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 MAIN ST STE 203B
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01721-1187
Mailing Address - Country:US
Mailing Address - Phone:508-881-3029
Mailing Address - Fax:508-881-1752
Practice Address - Street 1:29 HUDSON RD STE 3310
Practice Address - Street 2:
Practice Address - City:SUDBURY
Practice Address - State:MA
Practice Address - Zip Code:01776-1753
Practice Address - Country:US
Practice Address - Phone:978-443-8810
Practice Address - Fax:978-443-8839
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-26
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA74790207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3118592Medicaid
MA74790OtherSTATE LICENSE #
MAF67633Medicare UPIN
MA3118592Medicaid