Provider Demographics
NPI:1467518928
Name:CARON, DAVID (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:CARON
Suffix:
Gender:M
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:PO BOX 602362
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-2362
Mailing Address - Country:US
Mailing Address - Phone:704-279-1697
Mailing Address - Fax:704-279-1677
Practice Address - Street 1:115 BROWN ST SW
Practice Address - Street 2:SUITE 101
Practice Address - City:GRANITE QUARRY
Practice Address - State:NC
Practice Address - Zip Code:28072-0689
Practice Address - Country:US
Practice Address - Phone:704-279-1697
Practice Address - Fax:704-279-1677
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT184601207R00000X
NC200800898207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC232009OtherMEDICARE GROUP PTAN
NC5910164Medicaid
NC5910164Medicaid
NC2022719Medicare PIN