Provider Demographics
NPI:1518397587
Name:CAROLINA CARDIOLOGY, SLEEP & OBESITY CENTER PC
Entity Type:Organization
Organization Name:CAROLINA CARDIOLOGY, SLEEP & OBESITY CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHYAMAL
Authorized Official - Middle Name:KISHORE
Authorized Official - Last Name:MITRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:252-525-3290
Mailing Address - Street 1:3280 HENDERSON DR STE C
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-5290
Mailing Address - Country:US
Mailing Address - Phone:910-915-8450
Mailing Address - Fax:888-745-7026
Practice Address - Street 1:3280 HENDERSON DR STE C
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-5290
Practice Address - Country:US
Practice Address - Phone:910-915-8450
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-12
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207R00000X, 207RB0002X, 207RC0000X, 207RS0012X
NC00-35439207RC0000X, 207RS0012X, 207UN0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RB0002XAllopathic & Osteopathic PhysiciansInternal MedicineObesity MedicineGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear CardiologyGroup - Multi-Specialty