Provider Demographics
NPI:1730163908
Name:ANSEVIN, CARL FRANKLIN (MD)
Entity type:Individual
Prefix:DR
First Name:CARL
Middle Name:FRANKLIN
Last Name:ANSEVIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5701 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-2603
Mailing Address - Country:US
Mailing Address - Phone:330-726-7900
Mailing Address - Fax:330-726-7901
Practice Address - Street 1:7417 SOUTH AVE
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44512-5789
Practice Address - Country:US
Practice Address - Phone:330-726-7900
Practice Address - Fax:330-726-7901
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-01
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35038334A2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000132550OtherANTHEM
OH34148225100OtherBWC WORK COMP
OH0304718Medicaid
OH0304718Medicaid
OH7911133411Medicare PIN
OH000000132550OtherANTHEM