Provider Demographics
NPI:1649230921
Name:CAROLINA PEDIATRICS, PA
Entity Type:Organization
Organization Name:CAROLINA PEDIATRICS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:G
Authorized Official - Last Name:PIERCE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:252-332-5041
Mailing Address - Street 1:201 COLONY AVE S
Mailing Address - Street 2:
Mailing Address - City:AHOSKIE
Mailing Address - State:NC
Mailing Address - Zip Code:27910-3207
Mailing Address - Country:US
Mailing Address - Phone:252-332-5041
Mailing Address - Fax:252-332-6115
Practice Address - Street 1:201 COLONY AVE S
Practice Address - Street 2:
Practice Address - City:AHOSKIE
Practice Address - State:NC
Practice Address - Zip Code:27910-3207
Practice Address - Country:US
Practice Address - Phone:252-332-5041
Practice Address - Fax:252-332-6115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-23
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7901179Medicaid
NCC81514Medicare UPIN