Provider Demographics
NPI:1235322355
Name:CAROLINA PRIME INTERNAL MEDICINE,PA
Entity Type:Organization
Organization Name:CAROLINA PRIME INTERNAL MEDICINE,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BOYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GEORGIEV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-342-9969
Mailing Address - Street 1:1908 MEETING CT
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-6631
Mailing Address - Country:US
Mailing Address - Phone:910-342-9969
Mailing Address - Fax:
Practice Address - Street 1:1908 MEETING CT
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-6631
Practice Address - Country:US
Practice Address - Phone:910-342-9969
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-22
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9800541207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2308551Medicare PIN