Provider Demographics
NPI:1568484442
Name:CAROLINA GERIATRICS, PA
Entity Type:Organization
Organization Name:CAROLINA GERIATRICS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KAVITA
Authorized Official - Middle Name:S
Authorized Official - Last Name:PERSAUD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-799-5508
Mailing Address - Street 1:6300 SHINNCREEK LN
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28409-2152
Mailing Address - Country:US
Mailing Address - Phone:910-799-5508
Mailing Address - Fax:910-202-0654
Practice Address - Street 1:5919 OLEANDER DR STE 109
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-4757
Practice Address - Country:US
Practice Address - Phone:910-799-5508
Practice Address - Fax:910-202-0654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2330910Medicare PIN