Provider Demographics
NPI:1770787301
Name:CARNEVAL, MARY KATHERINE (DO)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:KATHERINE
Last Name:CARNEVAL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12301 SNOW ROAD
Mailing Address - Street 2:DEPARTMENT OF GENERAL SURGERY
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44130
Mailing Address - Country:US
Mailing Address - Phone:216-362-2262
Mailing Address - Fax:440-879-0084
Practice Address - Street 1:12301 SNOW ROAD
Practice Address - Street 2:DEPARTMENT OF GENERAL SURGERY
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44130
Practice Address - Country:US
Practice Address - Phone:216-362-2262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-009264208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery