Provider Demographics
NPI:1871547091
Name:PABLO M CARPIO, MD, PC
Entity type:Organization
Organization Name:PABLO M CARPIO, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PABLO
Authorized Official - Middle Name:M
Authorized Official - Last Name:CARPIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:276-988-8103
Mailing Address - Street 1:PO BOX 537
Mailing Address - Street 2:840 E. FINCASTLE TURNPIKE
Mailing Address - City:TAZEWELL
Mailing Address - State:VA
Mailing Address - Zip Code:24651-0537
Mailing Address - Country:US
Mailing Address - Phone:276-988-8103
Mailing Address - Fax:276-988-7858
Practice Address - Street 1:840 E FINCASTLE ST
Practice Address - Street 2:
Practice Address - City:TAZEWELL
Practice Address - State:VA
Practice Address - Zip Code:24651-1419
Practice Address - Country:US
Practice Address - Phone:276-988-8103
Practice Address - Fax:276-988-7858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2010-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101051616261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP00404190OtherRAILROAD MEDICARE
VA6059503Medicaid
VAG17542Medicare UPIN
VA6059503Medicaid