Provider Demographics
NPI:1093018095
Name:CAROLINA MEDICAL & MANAGEMENT CONSULTANTS, PLLC
Entity Type:Organization
Organization Name:CAROLINA MEDICAL & MANAGEMENT CONSULTANTS, PLLC
Other - Org Name:JEFFREY F. SEVERA, D.O.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:F
Authorized Official - Last Name:SEVERA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:252-339-4525
Mailing Address - Street 1:PO BOX 697
Mailing Address - Street 2:
Mailing Address - City:EDENTON
Mailing Address - State:NC
Mailing Address - Zip Code:27932-0697
Mailing Address - Country:US
Mailing Address - Phone:252-339-4525
Mailing Address - Fax:888-379-3488
Practice Address - Street 1:229 BAY POINT DR
Practice Address - Street 2:
Practice Address - City:EDENTON
Practice Address - State:NC
Practice Address - Zip Code:27932-8032
Practice Address - Country:US
Practice Address - Phone:252-339-4525
Practice Address - Fax:888-379-3488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-13
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PANC200400743207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89137KRMedicaid
NCH41683Medicare UPIN
NC89137KRMedicaid