Provider Demographics
NPI:1427170521
Name:NARDUCCI, CARL
Entity type:Individual
Prefix:
First Name:CARL
Middle Name:
Last Name:NARDUCCI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 6TH AVE S
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35233-1801
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1717 6TH AVE S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-1801
Practice Address - Country:US
Practice Address - Phone:800-822-8816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL257252085R0202X
ALMD257252085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009942732Medicaid
AL051540734OtherBLUE CROSS
AL051540735OtherBLUE CROSS
AL051540738OtherBLUE CROSS
AL051540736OtherBLUE CROSS
AL051540737OtherBLUE CROSS
AL009942729Medicaid
AL009942730Medicaid
AL009942731Medicaid
AL051540739OtherBLUE CROSS
AL009942728Medicaid
MS06808081Medicaid
AL009942727Medicaid
AL009942729Medicaid