Provider Demographics
NPI:1588805188
Name:CID PA
Entity Type:Organization
Organization Name:CID PA
Other - Org Name:CAROLINA INFECTIOUS DISEASE PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTINA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:RONNFELDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-568-3903
Mailing Address - Street 1:1774 METROMEDICAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-3861
Mailing Address - Country:US
Mailing Address - Phone:910-568-3903
Mailing Address - Fax:910-568-3908
Practice Address - Street 1:1774 METROMEDICAL DRIVE
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-3861
Practice Address - Country:US
Practice Address - Phone:910-568-3903
Practice Address - Fax:910-568-3908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-12
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207RI0200X
NC136028207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty