Basic Information
| Provider Information | |||||||||
| NPI: | 1275639783 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CARABALLO | ||||||||
| FirstName: | RICARDO | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 416457 | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 022416457 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9736566280 | ||||||||
| FaxNumber: | 9732907495 | ||||||||
| Practice Location | |||||||||
| Address1: | 6012 MAIN STREET | ||||||||
| Address2: | |||||||||
| City: | VOORHEES | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08043 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8563256622 | ||||||||
| FaxNumber: | 8563256522 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/15/2006 | ||||||||
| LastUpdateDate: | 07/25/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 25MA06319600 | NJ | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207VF0040X | NJMA63196 | NJ | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Female Pelvic Medicine and Reconstructive Surgery |
ID Information
| ID | Type | State | Issuer | Description | 2207042/7597015 | 01 | NJ | AETNA | OTHER | P2704813 | 01 | NJ | OXFORD | OTHER | 7780702 | 05 | NJ | MEDICAID | 3K7732 | 01 | NJ | HEALTHNET | OTHER | 0094687000 | 01 | NJ | AMERIHEALTH/KEYSTONE/IBC | OTHER | 010003742 | 01 | NJ | AMERICHOICE | OTHER | 1105869 | 01 | NJ | HORIZON NJ HEALTH | OTHER | 1949172 | 01 | NJ | UNITED HEALTHCARE | OTHER | 24212 | 01 | NJ | UNIVERSITY HEALTH PLAN | OTHER | 9402184 | 01 | NJ | CIGNA | OTHER |