Provider Demographics
NPI:1649468083
Name:CARMOUCHE, EDWIN F (MD)
Entity type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:F
Last Name:CARMOUCHE
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 1:152 CHENOWETH LN
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-2651
Mailing Address - Country:US
Mailing Address - Phone:502-895-7697
Mailing Address - Fax:502-895-7698
Practice Address - Street 1:152 CHENOWETH LN
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-2651
Practice Address - Country:US
Practice Address - Phone:502-895-7697
Practice Address - Fax:502-895-7698
Is Sole Proprietor?:No
Enumeration Date:2007-10-11
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY26724207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000305334OtherANTHEM
KY64267248Medicaid
E39235Medicare UPIN
KY000000305334OtherANTHEM
KY0784501Medicare PIN