Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | OS010329L | PA |
Y | 207QA0401X | Family Doctor - Addiction Medicine | OS010329L | PA |
NPI | 1346248291 |
---|---|
Provider Name | Christopher John Carbo |
First Address | Erie, PA 16505-8471 |
Second Address | Erie, PA 16509-2603 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2005 |
Last Update Date | 08/02/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0017853230005 | (05) | PA |
H07698 | (02) | PA |