Provider Demographics
NPI:1497735179
Name:CENTRAL CAROLINA MEDICAL ASSOCIATES, PA
Entity Type:Organization
Organization Name:CENTRAL CAROLINA MEDICAL ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:D
Authorized Official - Last Name:VEATCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-983-3855
Mailing Address - Street 1:1908 HILCO ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:ALBEMARLE
Mailing Address - State:NC
Mailing Address - Zip Code:28001-6307
Mailing Address - Country:US
Mailing Address - Phone:704-983-3855
Mailing Address - Fax:704-985-1031
Practice Address - Street 1:1908 HILCO ST
Practice Address - Street 2:SUITE B
Practice Address - City:ALBEMARLE
Practice Address - State:NC
Practice Address - Zip Code:28001-6307
Practice Address - Country:US
Practice Address - Phone:704-983-3855
Practice Address - Fax:704-985-1031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-19
Last Update Date:2014-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8984978Medicaid
NC8984978Medicaid