Provider Demographics
NPI:1548465917
Name:CARBONELL-SANCHEZ, IVAN (MPH, PA-C)
Entity type:Individual
Prefix:MR
First Name:IVAN
Middle Name:
Last Name:CARBONELL-SANCHEZ
Suffix:
Gender:M
Credentials:MPH, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18731 BLUE VIOLET LN
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20879-1529
Mailing Address - Country:US
Mailing Address - Phone:301-519-6890
Mailing Address - Fax:202-782-9169
Practice Address - Street 1:18731 BLUE VIOLET LN
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20879-1529
Practice Address - Country:US
Practice Address - Phone:301-519-6890
Practice Address - Fax:202-782-9169
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0001664363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical