Provider Demographics
NPI:1720092562
Name:CARABELLO, BLASE ANTHONY
Entity Type:Individual
Prefix:DR
First Name:BLASE
Middle Name:ANTHONY
Last Name:CARABELLO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 751649
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1649
Mailing Address - Country:US
Mailing Address - Phone:843-789-1620
Mailing Address - Fax:843-724-2440
Practice Address - Street 1:615 WESLEY DR STE 320
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-7274
Practice Address - Country:US
Practice Address - Phone:843-571-2939
Practice Address - Fax:843-606-8104
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY272639207RC0000X
NC2016-00791207RC0000X
SC12644207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCBCBSNCOther19J0Y
NC1720092562Medicaid
NCNCS6420322Medicare PIN