Provider Demographics
NPI:1255378394
Name:SIMONS, CARL I (MD)
Entity type:Individual
Prefix:DR
First Name:CARL
Middle Name:I
Last Name:SIMONS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 BATH RD
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:PA
Mailing Address - Zip Code:19007-3101
Mailing Address - Country:US
Mailing Address - Phone:215-785-9200
Mailing Address - Fax:215-785-9039
Practice Address - Street 1:501 BATH RD
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:PA
Practice Address - Zip Code:19007-3101
Practice Address - Country:US
Practice Address - Phone:215-785-9200
Practice Address - Fax:215-785-9039
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-31
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD027447L174400000X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAHIGHMARK BLUE SHIELDOther15410
PWIBCOther0021789000
PA101040658 0001Medicaid
PA30017309OtherKEYSTONE MERCY
PWIBCOther0021789000