Provider Demographics
NPI:1952597627
Name:CARMALT, E DUANE (MD)
Entity type:Individual
Prefix:
First Name:E DUANE
Middle Name:
Last Name:CARMALT
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 1:5620 WILBUR AVE
Mailing Address - Street 2:SUITE 307
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-1351
Mailing Address - Country:US
Mailing Address - Phone:818-881-9255
Mailing Address - Fax:818-881-3397
Practice Address - Street 1:5620 WILBUR AVE
Practice Address - Street 2:SUITE 307
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-1351
Practice Address - Country:US
Practice Address - Phone:818-881-9255
Practice Address - Fax:818-881-3397
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-17
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG23973207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G239730OtherCA MEDI-CAL
CAW21191Medicare PIN
CAWG23973AMedicare PIN