Provider Demographics
NPI:1578511713
Name:CARY INTERNAL MEDICINE & THE DIABETES CENTER PA
Entity Type:Organization
Organization Name:CARY INTERNAL MEDICINE & THE DIABETES CENTER PA
Other - Org Name:CARY INTERNAL MEDICINE PA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LARA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:JOPLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-467-6125
Mailing Address - Street 1:103 BAINES COURT
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-6646
Mailing Address - Country:US
Mailing Address - Phone:919-467-6125
Mailing Address - Fax:919-467-1728
Practice Address - Street 1:103 BAINES COURT
Practice Address - Street 2:SUITE 200
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-6646
Practice Address - Country:US
Practice Address - Phone:919-467-6125
Practice Address - Fax:919-467-1728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2010-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9800658207R00000X
NC9700997207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89011EJMedicaid
NC89011EJMedicaid