Provider Demographics
NPI:1447220827
Name:MENENDEZ, CAROLYN S (MD)
Entity Type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:S
Last Name:MENENDEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4101 MACON POND RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-6319
Mailing Address - Country:US
Mailing Address - Phone:919-782-8200
Mailing Address - Fax:
Practice Address - Street 1:4101 MACON POND RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-6319
Practice Address - Country:US
Practice Address - Phone:919-782-8200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME016523208600000X
NC2008-00011208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2008-00011OtherLICENSE
SCN11008Medicaid
NC1447220827Medicaid
NC2021781Medicare PIN
NCNC7435CMedicare PIN
MEI11232Medicare UPIN
NCNC7435AMedicare PIN
NCNC7435BMedicare PIN
NC5909101Medicaid
MEME1753Medicare PIN
NC2008-00011OtherLICENSE