Provider Demographics
NPI:1104018779
Name:CAROLINA INTERNAL MEDICINE OF SANFORD PA
Entity Type:Organization
Organization Name:CAROLINA INTERNAL MEDICINE OF SANFORD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:P
Authorized Official - Last Name:MICHAEL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:919-499-5151
Mailing Address - Street 1:4546 HWY 87 SOUTH
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27332-0212
Mailing Address - Country:US
Mailing Address - Phone:919-499-5151
Mailing Address - Fax:919-499-5147
Practice Address - Street 1:4546 HWY 87 SOUTH
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27332-0212
Practice Address - Country:US
Practice Address - Phone:919-499-5151
Practice Address - Fax:919-499-5147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-16
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200100910207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89129M4Medicaid
NC129M4OtherBCBS OF NC
NCDG1604OtherRAIL ROAD MEDICARE
NC89129M4Medicaid