Lee R Carrasco
Oral & Maxillofacial Surgeon
3400 Spruce Street 5 White Building
Philadelphia
, Pennsylvania 19104
Lee R Carrasco
Oral & Maxillofacial Surgeon
3400 Spruce Street 5 White Building
Philadelphia
, Pennsylvania 19104
(215) 662-3580
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About
Features
Specialties
- Oral & Maxillofacial Surgeon
Languages spoken
- English
Location
First Address
- Lee R Carrasco
- 3400 Spruce Street 5 White Building
- Philadelphia, PA
- Zip : 19104
- Phone : (215) 662-3580
Second Address
- Lee R Carrasco
- 3400 Spruce Street 5 White Building
- Philadelphia, PA
- Zip : 19104
- Phone : (215) 662-3580
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| N | 204E00000X | Oral & Maxillofacial Surgeon | DS031585L | PA |
| Y | 204E00000X | Oral & Maxillofacial Surgeon | MD418924 | PA |
National Provider Identifier
| NPI | 1013946540 |
|---|---|
| Provider Name | Lee R Carrasco |
| First Address | Philadelphia, PA 19104 |
| Second Address | Philadelphia, PA 19104 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 30/06/2006 |
| Last Update Date | 10/04/2013 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 0018942480001 | (05) | PA |
| H58705 | (02) |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.