Provider Demographics
NPI:1346201340
Name:CAROLINA PEDIATRICS
Entity Type:Organization
Organization Name:CAROLINA PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:FOREHAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-763-2476
Mailing Address - Street 1:715 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-7574
Mailing Address - Country:US
Mailing Address - Phone:910-763-2476
Mailing Address - Fax:910-763-8176
Practice Address - Street 1:715 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7574
Practice Address - Country:US
Practice Address - Phone:910-763-2476
Practice Address - Fax:910-763-8176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-29
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC28410305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service