Provider Demographics
NPI:1538124094
Name:CAROLINA PLASTIC SURGERY SPECIALISTS INC
Entity Type:Organization
Organization Name:CAROLINA PLASTIC SURGERY SPECIALISTS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LOVELLE-ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:252-384-0919
Mailing Address - Street 1:504 E ELIZABETH ST
Mailing Address - Street 2:STE 4
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-4472
Mailing Address - Country:US
Mailing Address - Phone:252-384-0919
Mailing Address - Fax:252-384-0916
Practice Address - Street 1:504 E ELIZABETH ST
Practice Address - Street 2:STE 4
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-4472
Practice Address - Country:US
Practice Address - Phone:252-384-0919
Practice Address - Fax:252-384-0916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8913349Medicaid
NC2333384Medicare ID - Type Unspecified
NC8913349Medicaid