Provider Demographics
NPI:1588675300
Name:CAROLINA MEDICAL ASSOCIATES, PA
Entity Type:Organization
Organization Name:CAROLINA MEDICAL ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:BRENT
Authorized Official - Last Name:PUGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:252-293-4444
Mailing Address - Street 1:2402 CAMDEN ST SW
Mailing Address - Street 2:SUITE 700
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27893-8608
Mailing Address - Country:US
Mailing Address - Phone:245-293-4444
Mailing Address - Fax:252-243-7044
Practice Address - Street 1:2402 CAMDEN ST SW
Practice Address - Street 2:SUITE 700
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-8608
Practice Address - Country:US
Practice Address - Phone:245-293-4444
Practice Address - Fax:252-243-7044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20100765207RP1001X
261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Not Answered261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89016AHMedicaid
NC89016AHMedicaid
NC2338297Medicare ID - Type Unspecified