Provider Demographics
NPI:1386693836
Name:ALBRIGHT, CARL RAY (DPM)
Entity type:Individual
Prefix:
First Name:CARL
Middle Name:RAY
Last Name:ALBRIGHT
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 SHERIDAN ST
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-3618
Mailing Address - Country:US
Mailing Address - Phone:570-326-1400
Mailing Address - Fax:570-326-2505
Practice Address - Street 1:1140 SHERIDAN ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-3618
Practice Address - Country:US
Practice Address - Phone:570-326-1400
Practice Address - Fax:570-326-2505
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC001372L213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
6048950001Medicare NSC
PAT-28078Medicare UPIN
PA116973Medicare ID - Type UnspecifiedGROUP PROVIDER ID
PA064601Medicare ID - Type UnspecifiedPROVIDER ID