Provider Demographics
NPI:1457383812
Name:CARLEVATO, NICHOLAS JOHN (MD)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:JOHN
Last Name:CARLEVATO
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 1:2102 IDAHO ST
Mailing Address - Street 2:
Mailing Address - City:ELKO
Mailing Address - State:NV
Mailing Address - Zip Code:89801
Mailing Address - Country:US
Mailing Address - Phone:775-315-2902
Mailing Address - Fax:775-460-2368
Practice Address - Street 1:2102 IDAHO ST
Practice Address - Street 2:
Practice Address - City:ELKO
Practice Address - State:NV
Practice Address - Zip Code:89801
Practice Address - Country:US
Practice Address - Phone:775-315-2902
Practice Address - Fax:775-460-2368
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV93072085R0202X, 2085R0204X
CAG752592085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFS4913489OtherMEDI-CAL
NV300113867OtherRAILROAD MEDICARE
CAAX103XOtherMEDICARE PTAN
NV33650OtherMEDICARE PTAN
NV002013136Medicaid
G16179Medicare UPIN