Provider Demographics
NPI:1134108434
Name:CAROLINA WOMENS CENTER PA
Entity Type:Organization
Organization Name:CAROLINA WOMENS CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:W
Authorized Official - Last Name:VAUGHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-693-9998
Mailing Address - Street 1:1018 COLLEGE STREET
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27565
Mailing Address - Country:US
Mailing Address - Phone:919-693-9998
Mailing Address - Fax:919-690-0334
Practice Address - Street 1:1018 COLLEGE STREET
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:NC
Practice Address - Zip Code:27565
Practice Address - Country:US
Practice Address - Phone:919-693-9998
Practice Address - Fax:919-690-0334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC790289CMedicaid
NC790289CMedicaid