Provider Demographics
NPI:1154086858
Name:CAROLINA INTERNAL MEDICINE ASSOCIATES PA
Entity Type:Organization
Organization Name:CAROLINA INTERNAL MEDICINE ASSOCIATES PA
Other - Org Name:CAROLINA INTERNAL MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:RAPHAEL
Authorized Official - Last Name:KUBITSCHEK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:828-258-0397
Mailing Address - Street 1:4 VANDERBILT PARK DR STE 100
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-2476
Mailing Address - Country:US
Mailing Address - Phone:828-258-0397
Mailing Address - Fax:828-277-7815
Practice Address - Street 1:275 MCDOWELL ST
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-2606
Practice Address - Country:US
Practice Address - Phone:828-258-0397
Practice Address - Fax:828-277-7815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-08
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty