Provider Demographics
NPI:1588704167
Name:CARNES, HARRY (MD)
Entity type:Individual
Prefix:
First Name:HARRY
Middle Name:
Last Name:CARNES
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 1:272 W ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:AUDUBON
Mailing Address - State:NJ
Mailing Address - Zip Code:08106-1565
Mailing Address - Country:US
Mailing Address - Phone:856-547-0811
Mailing Address - Fax:856-547-0891
Practice Address - Street 1:272 W ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:AUDUBON
Practice Address - State:NJ
Practice Address - Zip Code:08106-1565
Practice Address - Country:US
Practice Address - Phone:856-547-0811
Practice Address - Fax:856-547-0891
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA017191208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ087657Medicare PIN