Provider Demographics
NPI:1912986605
Name:EBY, CARL E (MD)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:E
Last Name:EBY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:991 ROUTE 19 N STE B
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:PA
Mailing Address - Zip Code:16441-9739
Mailing Address - Country:US
Mailing Address - Phone:814-877-8790
Mailing Address - Fax:814-796-4238
Practice Address - Street 1:991 ROUTE 19 N STE B
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:PA
Practice Address - Zip Code:16441-9739
Practice Address - Country:US
Practice Address - Phone:814-877-8790
Practice Address - Fax:814-796-4238
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD044330E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP00386434OtherRR MEDICARE
PAP000385OtherGATEWAY
PA608996OtherBLUE SHIELD
NY00026638202OtherUNIVERA
PA1442065OtherAETNA
PA205144OtherUPMC
OH2308505OtherOH MEDICAL ASSISTANCE
PA0012050020010Medicaid
NY02270684OtherNY MEDICAL ASSISTANCE
PA189979OtherUNISON
PA189979OtherUNISON
PA608996OtherBLUE SHIELD