Provider Demographics
NPI:1275688780
Name:CAROLINA PRIMARY CARE, P.A.
Entity Type:Organization
Organization Name:CAROLINA PRIMARY CARE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANELIA
Authorized Official - Middle Name:P
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-405-2100
Mailing Address - Street 1:6011 FAYETTEVILLE RD
Mailing Address - Street 2:SUITE 104A
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-6248
Mailing Address - Country:US
Mailing Address - Phone:919-405-2100
Mailing Address - Fax:919-806-2004
Practice Address - Street 1:6011 FAYETTEVILLE RD
Practice Address - Street 2:SUITE 104A
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-6248
Practice Address - Country:US
Practice Address - Phone:919-405-2100
Practice Address - Fax:919-806-2004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200000934207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89014KNMedicaid
NC014KNOtherBLUE CROSS BLUE SHIELD
NC2331616Medicare ID - Type Unspecified