Provider Demographics
NPI:1841262185
Name:CARBONARO, PAUL (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:CARBONARO
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 1:900 ROUTE 168
Mailing Address - Street 2:SUITE F5
Mailing Address - City:TURNERSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08012-3233
Mailing Address - Country:US
Mailing Address - Phone:856-232-7500
Mailing Address - Fax:856-232-7506
Practice Address - Street 1:900 ROUTE 168
Practice Address - Street 2:SUITE F5
Practice Address - City:TURNERSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08012-3233
Practice Address - Country:US
Practice Address - Phone:856-232-7500
Practice Address - Fax:856-232-7506
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-02
Last Update Date:2011-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07015900207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2619702Medicaid
H15412Medicare UPIN
NJ2619702Medicaid