Provider Demographics
NPI:1073553509
Name:CAROLINA REGIONAL ORTHOPAEDICS, PA
Entity Type:Organization
Organization Name:CAROLINA REGIONAL ORTHOPAEDICS, PA
Other - Org Name:CAROLINA REGIONAL ORTHOPAEDICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE SUPERVISOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:
Authorized Official - Last Name:BRAKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-823-7212
Mailing Address - Street 1:2906 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TARBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27886-1921
Mailing Address - Country:US
Mailing Address - Phone:252-823-7212
Mailing Address - Fax:252-823-5668
Practice Address - Street 1:2906 N MAIN ST
Practice Address - Street 2:
Practice Address - City:TARBORO
Practice Address - State:NC
Practice Address - Zip Code:27886-1921
Practice Address - Country:US
Practice Address - Phone:252-823-7212
Practice Address - Fax:252-823-5668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-06
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CK0207OtherRAILROAD MEDICARE
0174KOtherBCBS
NC890174KMedicaid
0174KOtherBCBS
CK0207OtherRAILROAD MEDICARE