Provider Demographics
NPI:1518358498
Name:CAROLINA AGE MANAGEMENT INSTITUTE, PC
Entity Type:Organization
Organization Name:CAROLINA AGE MANAGEMENT INSTITUTE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:GIORDANO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:704-997-6530
Mailing Address - Street 1:8712 LINDHOLM DR STE 302
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-1872
Mailing Address - Country:US
Mailing Address - Phone:704-997-6530
Mailing Address - Fax:704-997-6529
Practice Address - Street 1:8712 LINDHOLM DR STE 302
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-1872
Practice Address - Country:US
Practice Address - Phone:704-997-6530
Practice Address - Fax:704-997-6529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-12
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2007-01965207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty