Provider Demographics
NPI:1346457348
Name:CAROLINA FAMILY HEALTHCARE, PA
Entity Type:Organization
Organization Name:CAROLINA FAMILY HEALTHCARE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DINO
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:KANELOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-847-4000
Mailing Address - Street 1:1932 WEDDINGTON RD
Mailing Address - Street 2:
Mailing Address - City:WEDDINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28104-8318
Mailing Address - Country:US
Mailing Address - Phone:704-847-4000
Mailing Address - Fax:704-847-4001
Practice Address - Street 1:1932 WEDDINGTON RD
Practice Address - Street 2:
Practice Address - City:WEDDINGTON
Practice Address - State:NC
Practice Address - Zip Code:28104-8318
Practice Address - Country:US
Practice Address - Phone:704-847-4000
Practice Address - Fax:704-847-4001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9801330207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2337683Medicare ID - Type UnspecifiedGROUP NUMBER