Provider Demographics
NPI:1093991176
Name:YUSON, CARLO PILAPIL (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLO
Middle Name:PILAPIL
Last Name:YUSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 S HAWTHORNE RD
Mailing Address - Street 2:SUITE 358
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-3913
Mailing Address - Country:US
Mailing Address - Phone:336-768-5131
Mailing Address - Fax:
Practice Address - Street 1:1900 S HAWTHORNE RD
Practice Address - Street 2:SUITE 358
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3913
Practice Address - Country:US
Practice Address - Phone:336-768-5131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-18
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20641174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8989885Medicaid
NCC80882Medicare UPIN
NC8989885Medicaid