| Doctor Name: | MR. JOHN PETER DE CARLO |
| NPI Number: | 1588741243 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | MD029491E |
| Business Practice Address: | 7904 Bustleton Avenue Philadelphia, PA - 19152 |
| Business Phone Number: | 2157427212 |
| Business Fax Number: | 2157429014 |
| Mailing Address: | 7904 Bustleton Avenue, PHILADELPHIA |
| State: | PA |
| Postal Code: | 19152 |
| Phone Number: | 2157427212 |
| Fax Number: | 2157429014 |
| NPI Enumeration Date: | 11/01/2006 |
| NPI Last Update Date: | 06/20/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | MD029491E |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | PA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |