Provider Demographics
NPI:1639259781
Name:CAROLINAEAST PHYSICIANS
Entity Type:Organization
Organization Name:CAROLINAEAST PHYSICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP FINANCE/CFO
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SHERON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-633-8880
Mailing Address - Street 1:PO BOX 602522
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-2522
Mailing Address - Country:US
Mailing Address - Phone:252-633-1010
Mailing Address - Fax:252-224-3071
Practice Address - Street 1:137 MEDICAL LN
Practice Address - Street 2:
Practice Address - City:POLLOCKSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28573-8200
Practice Address - Country:US
Practice Address - Phone:252-633-1010
Practice Address - Fax:252-224-3071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201300820207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Multi-Specialty