Provider Demographics
NPI:1528018264
Name:ADULT & PEDIATRIC UROLOGY CENTER OF THE CAROLINAS PA
Entity Type:Organization
Organization Name:ADULT & PEDIATRIC UROLOGY CENTER OF THE CAROLINAS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:ROSS
Authorized Official - Last Name:GANGI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-423-4777
Mailing Address - Street 1:2835 E HWY 76
Mailing Address - Street 2:SUITE 3
Mailing Address - City:MULLINS
Mailing Address - State:SC
Mailing Address - Zip Code:29574
Mailing Address - Country:US
Mailing Address - Phone:843-423-4777
Mailing Address - Fax:843-423-0802
Practice Address - Street 1:2835 E HWY 76
Practice Address - Street 2:SUITE 3
Practice Address - City:MULLINS
Practice Address - State:SC
Practice Address - Zip Code:29574
Practice Address - Country:US
Practice Address - Phone:843-423-4777
Practice Address - Fax:843-423-0802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty