Individual
ALFREDO MAXIMILIANO CARBONELL II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
2104 WOODRUFF RD, GREENVILLE, SC 29607-5941
(864) 676-1072
(864) 676-0729
Mailing address
1 INDEPENDENCE PT STE 212, GREENVILLE, SC 29615-4536
(864) 797-6303
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
1102
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
011025
—
SC
01
—
P00452985
RR MEDICARE
SC
Enumeration date
11/02/2006
Last updated
02/01/2018
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