Provider Demographics
NPI:1952308322
Name:CARBONELL, CHRISTIAN (DPM)
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:
Last Name:CARBONELL
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 1:100 SHENANGO AVE
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:PA
Mailing Address - Zip Code:16146-1503
Mailing Address - Country:US
Mailing Address - Phone:724-342-6604
Mailing Address - Fax:724-342-1601
Practice Address - Street 1:63 PITT ST
Practice Address - Street 2:
Practice Address - City:SHARON
Practice Address - State:PA
Practice Address - Zip Code:16146-2102
Practice Address - Country:US
Practice Address - Phone:724-342-6604
Practice Address - Fax:724-342-1601
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36-00-2957213E00000X
PASC004315L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV2104024-000Medicaid
OH2040115Medicaid
PA01773940Medicaid
WV2104024-000Medicaid
OH2040115Medicaid
8017527Medicare ID - Type Unspecified
0896895Medicare ID - Type Unspecified
0896897Medicare ID - Type Unspecified
0896892Medicare ID - Type Unspecified
0896893Medicare ID - Type Unspecified
0896894Medicare ID - Type Unspecified
8017525Medicare ID - Type Unspecified
8017524Medicare ID - Type Unspecified
0896896Medicare ID - Type Unspecified
0896898Medicare ID - Type Unspecified
8017528Medicare ID - Type Unspecified
0896899Medicare ID - Type Unspecified
8017523Medicare ID - Type Unspecified
PA01773940Medicaid