Provider Demographics
NPI:1619484649
Name:PAIN AND WELLNESS SOLUTIONS OF THE CAROLINAS, PC
Entity Type:Organization
Organization Name:PAIN AND WELLNESS SOLUTIONS OF THE CAROLINAS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MANOJ
Authorized Official - Middle Name:BOBBY SUBBARAO
Authorized Official - Last Name:WUNNAVA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-590-3694
Mailing Address - Street 1:5322 HIGHGATE DR STE 143
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-6633
Mailing Address - Country:US
Mailing Address - Phone:984-464-7972
Mailing Address - Fax:919-591-0567
Practice Address - Street 1:5322 HIGHGATE DR STE 143
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713
Practice Address - Country:US
Practice Address - Phone:919-590-3694
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-28
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2009-00892207L00000X, 207LA0401X, 208VP0000X, 208VP0014X, 261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No207LA0401XAllopathic & Osteopathic PhysiciansAnesthesiologyAddiction MedicineGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPainGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5912627Medicaid