Provider Demographics
NPI:1093770240
Name:CAROLINA ENDOCRINE, P.A.
Entity Type:Organization
Organization Name:CAROLINA ENDOCRINE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:919-571-3661
Mailing Address - Street 1:3840 ED DR
Mailing Address - Street 2:SUITE 111
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-8005
Mailing Address - Country:US
Mailing Address - Phone:919-571-3661
Mailing Address - Fax:919-571-3290
Practice Address - Street 1:3840 ED DR
Practice Address - Street 2:SUITE 111
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-8005
Practice Address - Country:US
Practice Address - Phone:919-571-3661
Practice Address - Fax:919-571-3290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-19
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC98100717261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center