Provider Demographics
NPI:1194796201
Name:CARBONE, PAUL SEAN (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:SEAN
Last Name:CARBONE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:295 CHIPETA WAY
Mailing Address - Street 2:U OF U SOM DEPT OF PEDIATRICS
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84132-0001
Mailing Address - Country:US
Mailing Address - Phone:801-587-7400
Mailing Address - Fax:801-587-7417
Practice Address - Street 1:50 N MEDICAL DR
Practice Address - Street 2:GENERAL PEDIATRICS
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84132-0001
Practice Address - Country:US
Practice Address - Phone:801-581-3501
Practice Address - Fax:801-581-3899
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA061998208000000X
UT61338711205208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTD6737Medicaid
NV100510844Medicaid
UTG73181Medicare UPIN