Provider Demographics
NPI:1619933637
Name:CARLO P. YUSON MD PA
Entity Type:Organization
Organization Name:CARLO P. YUSON MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLO
Authorized Official - Middle Name:PILAPIL
Authorized Official - Last Name:YUSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-768-5131
Mailing Address - Street 1:1900 S.HAWTHORNE ROAD
Mailing Address - Street 2:SUITE 358
Mailing Address - City:WINSTON-SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103
Mailing Address - Country:US
Mailing Address - Phone:336-768-5131
Mailing Address - Fax:
Practice Address - Street 1:1900 S HAWTHORNE RD
Practice Address - Street 2:SUITE 358
Practice Address - City:WINSTON-SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3913
Practice Address - Country:US
Practice Address - Phone:336-768-5131
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-26
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20641261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8989885Medicaid
C80882Medicare UPIN
NC8989885Medicaid