Provider Demographics
NPI:1659411924
Name:CAROLINA NEPHROLOGY PA
Entity Type:Organization
Organization Name:CAROLINA NEPHROLOGY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:KEMP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-580-1026
Mailing Address - Street 1:1704A WAYNE MEMORIAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534
Mailing Address - Country:US
Mailing Address - Phone:919-580-1026
Mailing Address - Fax:919-580-1027
Practice Address - Street 1:1704A WAYNE MEMORIAL DRIVE
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534
Practice Address - Country:US
Practice Address - Phone:919-580-1026
Practice Address - Fax:919-580-1027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2005-00739207RN0300X
NC0094-00540207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC790294FMedicaid
1193EOtherBCBS
1932293131OtherPROVIDER INDIVIDUAL NPI
NC891193EMedicaid
0294FOtherBCBS
1225026289OtherPROVIDER INDIVIDUAL NPI
1790879997OtherPROVIDER INDIVIDUAL NPI
NC5901460Medicaid
14OUTOtherBCBS
2041913Medicare PIN
14OUTOtherBCBS
1790879997OtherPROVIDER INDIVIDUAL NPI
0294FOtherBCBS
1225026289OtherPROVIDER INDIVIDUAL NPI
P93442Medicare UPIN
NC5901460Medicaid